Evidence record
Dental Value-Added Services—Molina Healthcare
- Jurisdiction
- Texas
- Audit organization
- Texas Health and Human Services Office of Inspector General
- Publication date
- February 20, 2026
- Source record
- Original document linked
Findings
1
Recommendations
5
Overall conclusion
Molina did not consistently submit dental value-added services encounters with the correct financial arrangement code, which may affect the accuracy of FSR data and the computation of capitation rates and potential experience rebates.
Scope
September 1, 2022 through August 31, 2023.
Findings (1)
Each finding has a stable link.
- F-1143
Molina did not consistently submit dental value-added services encounters with the correct financial arrangement code. 13,654 of 23,303 encounters (59%) were coded as payable dental services (financial arrangement code 04) instead of value-added services (financial arrangement code 11), totaling $560,777.
Recommendations (5)
- R-1013
Implement controls to verify it reports STAR+PLUS dental value-added services encounters with the correct financial arrangement code.
Related finding F-1143 - R-1014
Correct the encounters and paid claims submitted with the incorrect financial arrangement code as applicable.
Related finding F-1143 - R-1015
Review its state fiscal year 2023, 2024, and 2025 FSRs to determine whether any reported dental value-added services expenses were included in the medical expenses.
Related finding F-1143 - R-1016
Contact HHSC Financial Reporting and Audit Coordination to receive guidance on the correction of any misreported medical expenses.
Related finding F-1143 - R-1017
Review its state fiscal year 2026 encounters to verify financial arrangement code 11 was used as applicable until a control is implemented.
Related finding F-1143