TX · Medicaid jurisdiction
Review reports connected to Texas Medicaid oversight, ordered by publication date.
23 reports
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.
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.
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…
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.
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.
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.
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…