Evidence record

Cook Children’s Health Plan’s Financial Statistical Reports

Jurisdiction: Texas
Publishing agency: Texas Health and Human Services Commission Office of Inspector General
Publication date: July 23, 2024
Source record: Original document linked

Open original reportOriginal source available

Findings

Recommendations

Overall conclusion

Cook Children’s Health Plan (CCHP) had a process for preparing financial statistical reports (FSRs), which included controls related to removing unallowable expenses and identifying the appropriate FSR sections for reporting allowable expenses. However, CCHP did not always sufficiently establish fair market value and incorrectly reported some expenses.

Scope

The audit scope covered selected expenses on CCHP’s FSRs for state fiscal year 2022, which covered the period from September 1, 2021, through August 31, 2022.

Findings (5)

Each finding has a stable link.

F-1188
CCHP did not sufficiently establish fair market value for four affiliates when negotiating rates or reporting $243,764,253 of these expenses on its FSRs; only one affiliate’s rate was supported as fair market value.
F-1189
Understated overall salaries, wages, and benefits expenses by $212,870 on the FSRs.
F-1190
Understated outsourced behavioral health services expenses by $59,742 on the FSRs.
F-1191
Incorrectly categorized some salaries, wages, and benefits expenses on the FSRs.
F-1192
Excluded affiliate expenses from an informational subsection on the FSRs.

Recommendations (4)

R-1052
Implement a process to establish fair market value for affiliate expenses reported on FSRs.
Related finding F-1188
R-1053
Follow instructions from HHSC FRAC to determine the impact of not sufficiently establishing fair market value for the identified affiliates.
Related finding F-1188
R-1054
Implement a process to accurately report salaries, wages, and benefits expenses; outsourced services expenses; and affiliate medical expenses.
Related finding F-1189
R-1055
Follow instructions from FRAC to determine the impact of incorrectly reporting salaries, wages, and benefits expenses; outsourced services expenses; and affiliate expenses.
Related finding F-1191