Evidence record
Follow-Up Assessment on a Previously Published Audit Report Managed Care Claims Submitted by Cook Children’s Home Health
- Jurisdiction
- Texas
- Audit organization
- Texas Health and Human Services Office of Inspector General Audit and Inspections Division
- Publication date
- February 11, 2025
- Source record
- Original document linked
Findings
5
Recommendations
2
Overall conclusion
Based on our assessment, Cook Children’s Home Health did not fully resolve some reported audit issues and the agency must repay $1,064.92 to the state of Texas for overpayments identified during this assessment; two recommendations from the previous audit were reissued and modified as appropriate.
Scope
The follow-up assessment tested the resolution status of issues identified in the previously published audit report AUD-22-002 concerning Cook Children’s Home Health. Testing covered durable medical equipment and supplies claims paid to Cook Children’s Home Health, with payments evaluated for claims and related documentation for March 1, 2023, through February 29, 2024. The engagement was conducted from September 24, 2024, through January 8, 2025, including review of order forms, prior authorizations, delivery tickets, and delivery confirmations; data reliability was assessed by comparing encounter data to medical records and interviewing staff.
Findings (5)
Each finding has a stable link.
- F-1153
Cook Children’s Home Health did not fully resolve some previously identified audit issues; two recommendations from the prior audit were reissued with modifications.
- F-1154
Overpayments totaling $1,064.92 were identified during this assessment and must be repaid to the state of Texas.
- F-1155
Issues identified include duplicate claims, incorrect/delivered quantities, and unauthorized items; testing of 7 of 19 members (36.8%) showed billing irregularities.
- F-1156
Controls to match delivery order quantities with authorizations and to identify/reverse duplicate claims were implemented but not always effective; further evaluation of duplicate detection controls is required.
- F-1157
Specific repayments identified in prior recommendations include $2,523.50 (1b) and $905.82 (2b); plus note that the assessment identified overall overpayments of $1,064.92.