The IG Quarterly Report for the second quarter of fiscal year 2019.

This report details the inspection to determine if managed care organization member complaint intake processes are consistent with the Uniform Managed Care Contract and Uniform Managed Care Manual requirements. Issued March 7, 2019.

This report details the inspection to determine if documentation requirements are being met when Medicaid clients receive power wheelchairs from durable medical equipment suppliers. Issued February 27, 2019.

This report details the inspection to determine the program integrity activities pharmacy benefit managers use to detect fraud, waste, and abuse of Medicaid-funded prescriptions. Issued February 27, 2019.

The audit evaluated Epic to determine whether it properly billed the MCO FirstCare Health Plans for Medicaid claims and complied with contractual and state requirements. Issued February 26, 2019.

The audit evaluated whether paid Medicaid claims for air ambulance services and their associated ground transports were billed in accordance with state rules and guidelines, and contractual requirements. Issued February 26, 2019

The objective of the audit was to determine the reliability of UnitedHealthcare sub-capitated encounter data and claims-based encounter data.  Issued February 26, 2019.

The OIG presentation on technology projects given to the House Appropriations Subcommittee on Article II on February 19, 2019.

This article explains how to prevent being the target of fraud or abuse in your home. Issued February 15, 2019.

The OIG presentation given to the House Appropriations Subcommittee on Article II on February 12, 2019.

The OIG presentation given to the Senate Finance Committee on February 5, 2019.

The audit evaluated Metscript Pharmacy No. 2 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 11, 2019.

Issue Brief: Encounter Data

January 2019 Issue Briefs

This Issue Brief outlines how the OIG uses encounter data (a record of paid cliams by MCOs and DMOs) to monitor and detect fraud, waste, and abuse. Issued January 17, 2019.

This report details the inspection to determine if home health providers obtain and evaluate background information on attendant care personnel to ensure client safety. Issued January 16, 2019.

This report details the inspection to determine if HHSC Access and Eligibility Services properly addresses non-verified Social Security numbers to prevent ineligible client enrollment in Texas Medicaid. Issued January 3, 2019.

Quarterly Report: Quarter 1, FY 2019

December 2018 Quarterly

The IG Quarterly Report for the first quarter of fiscal year 2019.

This audit evaluated whether fee-for-service claims submitted by and paid to Bethesda Lutheran were authorized, documented, and billed in accordance with the HCS provider agreement and with state rules and guidelines. Issued December 14, 2018.

This audit evaluated whether claims for residential support services and supervised living submitted by and paid to Lakes Regional and authorizations for other HCS services existed were properly documented. Issued November 30, 2018.

This audit evaluated whether claims for residential support services and supervised living submitted by and paid to Mission Road and authorizations for other HCS services existed were properly documented. Issued November 30, 2018.

The audit evaluated Avita Drugs 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 November 30, 2018.

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