Evidence record
An Audit Report on Cook Children’s Health Plan, a Managed Care Organization
- Jurisdiction
- Texas
- Publishing agency
- Texas State Auditor's Office
- Publication date
- July 2022
- Source record
- Original document linked
Findings
1
Recommendations
1
Overall conclusion
Cook Children’s Health Plan accurately reported STAR Kids medical and pharmacy expenses in FY 2020 and complied with eligibility requirements for medical and pharmacy claims. However, improvements are needed in reporting shared administrative expenses, particularly those allocated from its parent company, which included unallowable expenses. The plan also needs to strengthen its processes for verifying shared expenses and timesheet approvals. The report highlights strengths in medical and prescription expense reporting but emphasizes the importance of internal controls and compliance with cost principles.
Scope
The scope of this audit included Cook Children’s Health Plan’s financial processes and controls for fiscal year 2020, specifically focusing on the STAR Kids, administrative expenses, and quality improvement financial statistical reports, as well as the reported medical and pharmacy claims and related internal control components.
Findings (1)
Each finding has a stable link.
- F-948
the Health Plan reported shared expenses that were not allowed under the Health and Human Services Commission’s cost principles, including expenses that exclusively benefited the Health Plan’s affiliate providers.
Recommendations (1)
- R-840
The Health Plan should work with its parent company to strengthen the Health Plan’s processes and controls so that: Shared expenses reported (1) reflect valid expenses and (2) benefit the Health Plan. Timesheets are reviewed in accordance with the Commission’s and the parent company’s requirements.
Related finding F-948