Medicaid Audit Intelligence

Publishing agency

Centers for Medicare & Medicaid Services

Reports attributed to this canonical publisher identity in the public audit registry.

Evidence register

8 reports

Published
Sep 2026
Scope
National
Source authority
Federal
Publishing agency
Centers for Medicare & Medicaid Services
Source record
Metadata record
Examines
National scope

Medicaid Managed Care: CMS’s Accuracy Check Process For State-Submitted MLR Data Has Limitations

CMS’s oversight of State-submitted Medicaid MLR data has limitations due to reliance on optional data elements and lack of internal communication; while CMS has taken steps such as releasing an MLR Toolkit, implementing a web-based submission portal, and making MLR data public…

Findings
6
Recommendations
3
Open evidence record
Source status
Library record
Published
Sep 2, 2026
Scope
National
Source authority
Federal
Publishing agency
Centers for Medicare & Medicaid Services
Source record
Original document linked
Examines
National scope

CMS Could Improve Oversight of States' Use of Contract Surveyors for Nursing Home Surveys

CMS did not provide adequate oversight of State survey agencies’ use of contract surveyors to conduct nursing home surveys, increasing the risk that Federal requirements are not consistently met.

Findings
4
Recommendations
2
Open evidence record
Source status
Original source
Published
Jul 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
Centers for Medicare & Medicaid Services
Source record
Original document linked
Examines
Arizona

Arizona Medicaid Managed Care Medical Loss Ratio Audit

While the audit identified areas for improvement in reporting consistency and oversight, Arizona’s Medicaid Managed Care Plans demonstrated MLR performance above the federal minimum threshold during the audit period. Implementing the recommendations will improve data integrity…

Findings
8
Recommendations
10
Open evidence record
Source status
Original source
Published
Aug 2025
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
Centers for Medicare & Medicaid Services
Source record
Original document linked
Examines
Washington

Washington Medicaid Managed Care Medical Loss Ratio Audit

CMS identified eight findings requiring correction, but none resulted in an MLR recalculation below the 85% remittance threshold; the audit identified operational improvements and oversight enhancements to ensure compliance with federal MLR requirements.

Findings
8
Recommendations
6
Open evidence record
Source status
Original source
Published
Jul 25, 2025
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
Centers for Medicare & Medicaid Services
Source record
Original document linked
Examines
Ohio

Ohio Medicaid Managed Care Medical Loss Ratio Audit

While no remittances were required based on the findings, the audit identified multiple areas for improvement in Ohio’s oversight and reporting processes to ensure compliance with federal requirements and enhance program integrity.

Findings
3
Recommendations
11
Open evidence record
Source status
Original source
Published
May 30, 2025
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
Centers for Medicare & Medicaid Services
Source record
Original document linked
Examines
Ohio

Oklahoma Focused Program Integrity Review Final Report

CMS supports Oklahoma’s efforts and encourages further improvements in program integrity. The review identified four observations for the state’s attention but no non-compliance findings that pose a risk.

Findings
1
Recommendations
5
Open evidence record
Source status
Original source
Published
Aug 1, 2023
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
Centers for Medicare & Medicaid Services
Source record
Original document linked
Examines
Kansas

Kansas Medicaid and CHIP Eligibility Determinations Audit

The audit found that Kansas generally complies with eligibility determination requirements but identified significant areas for improvement, especially in documentation, timely case closure, and resource verification. The improper payments highlight the need for enhanced overs…

Findings
5
Recommendations
8
Open evidence record
Source status
Original source
Published
Mar 1, 2023
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
Centers for Medicare & Medicaid Services
Source record
Original document linked
Examines
Oregon

Oregon Medicaid Managed Care Medical Loss Ratio Audit

The audit identified areas for improvement in Oregon's Medicaid managed care MLR reporting and oversight processes. While no immediate remittance was required, implementing the recommendations will enhance compliance, accuracy, and program integrity.

Findings
2
Recommendations
10
Open evidence record
Source status
Original source