Public audit ledger
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9 reports
Wellpoint did not consistently submit dental value-added services encounters with the correct financial arrangement code.
Superior HealthPlan, Inc. did not consistently submit dental value-added services encounters with the correct financial arrangement code.
AES had processes and controls to prevent and detect the creation of multiple IDs and associated overpayments, but improvements can be made to further limit the creation of multiple IDs for Texas Medicaid and CHIP members.
The Wellpoint Texas SIU did not consistently comply with state and contractual requirements related to preventing, detecting, and investigating fraud, waste, and abuse and reporting reliable information on SIU activities, results, and recoveries to the Texas Health and Human S…
UnitedHealthcare Dental had a process for preparing and reviewing FSRs; however, internal controls were not always effective and allowed for reporting errors, which resulted in overstating reported expenses by $799,351.
CaremarkPCS Health, LLC (Caremark) and Aetna Better Health of Texas Inc. (Aetna) employed unallowable pricing models to reduce prescription expenses, and Aetna incorrectly reported expenses on its financial statistical reports to HHSC.
Omnicare Pharmacy (Omnicare) filled and dispensed prescriptions for Texas Medicaid members; however, Omnicare did not consistently comply with certain requirements for dispensing medication, confirming medication delivery, providing instructions for use, and accurately submitt…
Meadowbrook Pharmacy filled and dispensed prescriptions for Texas Medicaid and CHIP members; however, Meadowbrook did not consistently comply with certain requirements for dispensing refills, accurately submitting claims, providing instructions for use, and maintaining support…
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 suf…