This report details the inspection to determine if Texas Medicaid made multiple capitation payments for clients with multiple Medicaid ID numbers. Issued June 8, 2018.
Report Fraud1-800-436-6184
The audit evaluated Specialty Therapeutic Care to determine whether it properly billed VDP and complied with contractual and state requirements, and evaluated IT general controls to determine whether data used for audit testing was reliable. Issued May 31, 2018.
This report details the inspection of capitation payments made for deceased clients in the Texas Medicaid system, to determine how processes can be strengthened to identify and recoup those payments. Issued May 29, 2018.
This report details the inspection of the Electronic Visit Verification (EVV) System to determine how effective it is at verifying that home visits for Medicaid clients occurred and at confirming that home services were provided. Issued May 29, 2018.
The audit evaluated Minimum Data Set (MDS) assessments, therapy services charts, medical records, Resource Utilization Group (RUG) levels assigned to residents, and physician orders and certifications for therapy services. Issued May 11, 2018.
This presentation was made by Inspector General Sylvia Hernandez Kauffman on the topic of program integrity in managed care.
This issue brief provides an overview of attendant care services, which provide Medicaid clients the assistance they need to stay in their community, instead of living in a long-term care (LTC) facility.
The audit evaluated Cook Children’s Home Health to determine whether it properly billed VDP and complied with contractual and state requirements, and evaluated IT general controls to determine whether data used for audit testing was reliable.
The audit evaluated whether fee-for-service claims for incontinence supplies paid with Medicaid funds were billed in accordance with state laws, regulations, and program requirements. Issued April 27, 2018.
The audit evaluated Driscoll’s policies and practices associated with preventing, detecting, investigating, and reporting fraud, waste, and abuse. Issued April 3, 2018.
Texas Medicaid and CHIP Managed Care Organizations’ Special Investigative Units Review and Recommendations
March 2018 OtherThis report was submitted to the Legislative Budget Board and the Governor in compliance with the 2018-2019 General Appropriations Act, Senate Bill 1, 85th Legislature, Regular Session, 2017 (Article II, Health and Human Services Commission, Rider 152). Issued March 29, 2018.
The IG Quarterly Report for the second quarter of fiscal year 2018.
The IG Quarterly Report for the first quarter of fiscal year 2018.
Review of Managed Care Organizations' Cost Avoidance and Waste Prevention Activities
March 2018 OtherThis report was submitted to the Legislative Budget Board and the Governor in compliance with the 2018-2019 General Appropriations Act, Senate Bill 1, 85th Legislature, Regular Session, 2017 (Article II, Health and Human Services Commission, Rider 151.) Issued March 1, 2018.
Security Controls Over Confidential HHS System Information: MAXIMUS Enrollment Broker
February 2018 AuditThe audit evaluated the design and effectiveness of selected security controls over confidential HHS System information stored and processed by MAXIMUS. Issued February 23, 2018.
The audit evaluated Southside Pharmacy to determine whether it properly billed VDP and complied with contractual and state requirements, and evaluated IT general controls to determine whether data used for audit testing was reliable. Issued February 9, 2018; revised February 28, 2018.
This report was submitted to the Legislative Budget Board and the Governor in compliance with the 2018-2019 General Appropriations Act, Senate Bill 1, 85th Legislature, Regular Session, 2017 (Article II, Health and Human Services Commission, Rider 153). Issued February 1, 2018.
The audit evaluated whether fee-for-service claims for incontinence supplies paid with Medicaid funds were billed in accordance with state laws, regulations, and program requirements. Test results indicated no exceptions. Issued December 20, 2017.
Homelife and Community Services, Inc.: A Texas Home and Community-Based Services Program Provider
November 2017 AuditThis audit evaluated whether claims for Residential Support Services submitted by and paid to Homelife and authorizations for billed Day Habilitation services existed were properly documented. Issued November 30, 2017.
Audit of Children’s Hope Residential Services, Inc.: Residential Child-Care Contracts with The Texas Department of Family and Protective Services
November 2017 AuditThe audit evaluated whether state funds were used as intended for facility maintenance and payments to foster parents and whether Children’s Hope met contract requirements for supervising children, performing inventories, and documenting services. Issued November 30, 2017.