The objectives of this audit were to determine whether claims were authorized, documented, and billed in accordance with the provider agreement, state rules, and guidelines Results indicated no exceptions for the records or claims tested. Issued October 15, 2018.
The IG Quarterly Report for the fourth quarter of fiscal year 2018.
The Consolidated Senate Bill 30 Annual Report for fiscal year 2018.
The annual PARIS-VA Match Report for fiscal year 2018.
The audit evaluated Blue Cross and Blue Shield’s policies and practices associated with preventing, detecting, investigating, and reporting fraud, waste, and abuse. Issued September 28, 2018.
This report details the inspection to determine if Texas Medicaid processes identify or prevent duplicate capitation payments to managed care organizations for clients enrolled in both Medicaid and the Children’s Health Insurance Program. Issued August 28, 2018.
This report details the inspection to determine whether HHSC Customer Care Center responses to OIG match action alerts prevent Supplemental Nutrition Assistance Program and Medicaid overpayments. Issued August 21, 2018.
This report details the inspection to determine if Community Attendant Services are billed to Medicaid and rendered to clients in accordance with program requirements. Issued August 7, 2018.
The audit was conducted to determine whether confidential HHS System information in the custody of Community First and its subcontractors was protected from unauthorized access, loss, or disclosure. Issued August 2, 2018.
The audit evaluated Premier Care Pharmacy Services 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 July 31, 2018.
The audit evaluated Amber 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 July 31, 2018.
This report details OIG's review of previously published reports, audits, and investigations of Texas HHS procurements published between 2013-2018.
The audit evaluated whether Himmel complied with Texas Medicaid requirements for speech therapy authorizations, discontinuation, and claims billing; licensure, certification, and supervision of speech therapists; and medical necessity of speech therapy treatments. Issued July 23, 2018.
The IG Quarterly Report for the third quarter of fiscal year 2018.
The OIG Audit Division performed an inventory of selected drugs to determine whether Richard's Pharmacy correctly billed Medicaid, complied with requirements, and maintained sound controls over its related IT systems for the audit period. Issued June 27, 2018.
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.
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.
