Public audit ledger
Search the complete report library and verify each record against its publishing agency and original public source.
16 reports
Superior HealthPlan, Inc. did not consistently submit dental value-added services encounters with the correct financial arrangement code.
Wellpoint did not consistently submit dental value-added services encounters with the correct financial arrangement code.
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.
Based on our assessment, Encore Pharmacy #1 fully resolved all reported audit issues. As a result, OIG Audit did not reissue any recommendations from the previous audit.
The Blue Cross and Blue Shield of Texas Special Investigative Unit did not operate an effective SIU program and did not comply with requirements related to preventing, detecting, and investigating fraud, waste, and abuse, and reporting accurate information on SIU activities, r…
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…
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 mod…
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.
While all five providers complied with some of the requirements tested, each had at least one finding of noncompliance.
The Texas OIG found that the involved entities employed unallowable pricing practices to reduce prescription expenses, and Wellpoint incorrectly reported expenses on FSRs, with scope limitations due to Caremark's restricted access. The report concludes that these practices, in…
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…
ReCept Pharmacy #1 properly billed for paid claims and complied with applicable contractual, Texas Administrative Code, and federal requirements for most claims tested; however, ReCept did not consistently comply with requirements for accurate claims submissions and dispensing…