Medicaid Audit Intelligence

Publishing agency

U.S. Department of Health and Human Services, Office of Inspector General

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

Evidence register

53 reports

Published
Oct 28, 2026
Scope
Multi-jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Original document linked
Examines
4 jurisdictions · Massachusetts, New Jersey + 2 more

Four States Implemented Different Nursing Home Minimum Spending Requirements Related to Resident Care, and Three of These States and Some Nursing Homes Experienced Challenges

The four states implemented their own nursing home minimum spending requirements related to resident care and faced challenges in data collection and reporting, suggesting CMS should factor these findings into future Medicaid payment transparency efforts and potential rulemaking.

Findings
2
Recommendations
1
Open evidence record
Source status
Original source
Published
Sep 2026
Scope
National
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Metadata record
Examines
National scope

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

CMS did not provide adequate oversight of States’ use of contract surveyors to conduct nursing home surveys, increasing the risk that contract surveyors do not meet Federal requirements; CMS concurred with the recommendations.

Findings
6
Recommendations
2
Open evidence record
Source status
Library record
Published
Sep 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Metadata record
Examines
Alabama

Alabama Medicaid Fraud Control Unit: 2025 Inspection

Overall, the Alabama MFCU generally performed in line with many standards and produced substantial case outcomes, but the inspection identified deficiencies in staffing, referral generation, case information management, and coordination with Federal partners. OIG recertified t…

Findings
14
Recommendations
9
Open evidence record
Source status
Library record
Published
Sep 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Metadata record
Examines
New York

New York Medicaid Managed Care Capitation Payments for Incarcerated Enrollees

New York made unallowable managed care capitation payments totaling $7,551,670 ($6,164,734 Federal share) on behalf of 1,375 incarcerated Medicaid enrollees and did not consistently disenroll incarcerated enrollees; recommendations include refunding the Federal share and stren…

Findings
3
Recommendations
2
Open evidence record
Source status
Library record
Published
Sep 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Metadata record
Examines
California

California Did Not Report and Return All Medicaid Overpayments for the State’s Medicaid Fraud Control Unit Cases

The State agency did not report and return the Federal share of all Medicaid Fraud Control Unit-determined Medicaid overpayments identified for FY 2023.

Findings
6
Recommendations
4
Open evidence record
Source status
Library record
Published
Sep 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Metadata record
Examines
Tennessee

Tennessee Claimed Federal Medicaid Reimbursement for Millions of Dollars in Targeted Case Management Services That Did Not Comply With Federal and State Requirements

The OIG concluded that Tennessee claimed Federal Medicaid reimbursement for a subset of TCM services during FYs 2021–2023 that did not comply with Federal and State requirements, due to failure to verify eligibility for the designated target group and to assess TEIS cases prop…

Findings
4
Recommendations
2
Open evidence record
Source status
Library record
Published
Sep 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Metadata record
Examines
Georgia

Georgia Medicaid Fraud Control Unit: 2024 Onsite Inspection

The Georgia MFCU demonstrated active case progression and collaboration with federal partners, but faced persistent governance and control gaps, including staffing shortages, incomplete supervisory documentation, lack of formal equipment inventory policies, and delays in repor…

Findings
9
Recommendations
6
Open evidence record
Source status
Library record
Published
Sep 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Metadata record
Examines
South Carolina

South Carolina Did Not Report Approximately $108.6 Million of the Federal Share of Medicaid and CHIP Collections Subject to the Increased COVID-19 Federal Medical Assistance Percentage

The OIG determined that South Carolina did not accurately calculate and report the Federal share of Medicaid and CHIP collections subject to the increased COVID-19 FMAP during the audit period, resulting in underreporting of the Federal share (approximately $99.98 million, plu…

Findings
5
Recommendations
4
Open evidence record
Source status
Library record
Published
Sep 30, 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Original document linked
Examines
Wisconsin

Wisconsin May Have Improperly Claimed $455 Million in Medicaid Reimbursement for Its School-Based Program

Wisconsin may have improperly claimed Federal Medicaid reimbursement for its school-based program, and the OIG issued six recommendations to recover funds or support costs and to strengthen RMTS and related controls.

Findings
4
Recommendations
6
Open evidence record
Source status
Original source
Published
Sep 21, 2026
Scope
National
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Original document linked
Examines
National scope

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

The OIG identified limitations in CMS's process to verify State-submitted Medicaid MLR data and recommended procedures to address inaccuracies, with CMS concurring.

Findings
3
Recommendations
3
Open evidence record
Source status
Original source
Published
Sep 21, 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Original document linked
Examines
New York

New York Made Unallowable Managed Care Capitation Payments on Behalf of Incarcerated Medicaid Enrollees

The audit identifies a sizeable unallowable capitation payment amount ($7.55 million total with $6.164 million federal share) to New York’s Medicaid managed care organizations on behalf of incarcerated enrollees, with recommended refund and policy-strengthening actions. The fi…

Findings
1
Recommendations
2
Open evidence record
Source status
Original source
Published
Aug 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Metadata record
Examines
Arizona

Arizona Did Not Ensure That Selected Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization

The State agency did not ensure that all selected MCOs conducted annual parity analyses and adequately oversight; as a result, parity compliance could not be confirmed, potentially delaying or obstructing MH/SUD treatment for Medicaid enrollees.

Findings
2
Recommendations
3
Open evidence record
Source status
Library record
Published
Aug 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Metadata record
Examines
North Dakota

North Dakota Medicaid Fraud Control Unit: 2025 Inspection

The Unit did not fully conform to several performance standards during FYs 2022–2024, but concurred with all recommendations and has taken corrective actions, including implementing a new case management system in 2026 and updating the MOU with CMS standards. This progress is…

Findings
8
Recommendations
6
Open evidence record
Source status
Library record
Published
Aug 13, 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Original document linked
Examines
Kansas

Kansas Did Not Ensure That Its Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization

Kansas did not ensure that its Medicaid MCOs complied with MH/SUD parity requirements related to prior authorization for MH/SUD services for calendar year 2023, and deficiencies in parity analyses, data quality, and state oversight indicate potential barriers to access for MH/…

Findings
4
Recommendations
3
Open evidence record
Source status
Original source
Published
Aug 13, 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Original document linked
Examines
New York

New York Did Not Ensure That Selected Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization

New York did not ensure that all three selected Medicaid managed care organizations complied with MH/SUD parity requirements related to prior authorization.

Findings
3
Recommendations
2
Open evidence record
Source status
Original source
Published
Jun 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Original document linked
Examines
Pennsylvania

Medicaid Managed Care Behavioral Health Service Denials in Philadelphia by Community Behavioral Health

CBH did not comply with Federal and State requirements for denying prior-authorization behavioral health services; none of the 100 sampled denials complied with all applicable requirements, indicating potential systemic issues in denials and potential impact on enrollee rights.

Findings
5
Recommendations
6
Open evidence record
Source status
Original source
Published
Jun 2026
Scope
Multi-jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Original document linked
Examines
5 jurisdictions · Louisiana, Missouri + 3 more

Inaccurate Medicaid Managed Care Provider Directories May Limit Enrollees’ Access to Maternal Health Care

Online provider directories of Centene, Elevance, and UnitedHealthcare Medicaid plans in five States contained inaccuracies (ghost providers, missing in-network providers, and incorrect contact information) that may impede enrollees' access to maternal health care and distort…

Findings
4
Recommendations
2
Open evidence record
Source status
Original source
Published
Jun 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Original document linked
Examines
North Dakota

North Dakota Could Better Ensure That Providers Fully Comply With Federal Waiver and State Health, Safety, and Administrative Requirements at 44 Residential Settings

The North Dakota State agency could improve oversight of residential providers and settings to better ensure the health and safety of participants with intellectual and developmental disabilities residing in residential habilitation settings; weaknesses in the quality manageme…

Findings
7
Recommendations
3
Open evidence record
Source status
Original source
Published
Jun 2026
Scope
Multi-jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Original document linked
Examines
5 jurisdictions · Louisiana, Missouri + 3 more

Inaccurate Medicaid Managed Care Network Lists May Compromise State Oversight of Access to Maternal Health Care

We found that the network lists from Centene, Elevance, and UnitedHealthcare Medicaid plans in five States contained inaccuracies—potential ghost providers who reported not being in-network, incorrect contact information, and discrepancies with online provider directories—that…

Findings
3
Recommendations
2
Open evidence record
Source status
Original source
Published
Jun 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Original document linked
Examines
California

California's Medicaid Reimbursements for Clinical Diagnostic Laboratory Services

The State agency did not always claim Federal Medicaid reimbursement for clinical diagnostic laboratory services in accordance with Federal and State requirements, resulting in overpayments totaling $13.9 million (Federal share) and potentially $29.3 million (Federal share not…

Findings
4
Recommendations
4
Open evidence record
Source status
Original source
Published
Jun 2026
Scope
National
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Original document linked
Examines
National scope

CMS Should Improve Its Policies and Procedures for the Oversight of States’ Reported Medicaid Expenditures to Better Protect the Financial Integrity of the Medicaid Program

CMS did not consistently follow its policies and procedures for overseeing States’ CMS-64 expenditures and its processes for deferred payments and disallowed expenditures require improvements to protect Medicaid financial integrity.

Findings
3
Recommendations
4
Open evidence record
Source status
Original source
Published
Mar 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Original document linked
Examines
Louisiana

Medicaid Managed Care Behavioral Health Services Denials in Louisiana

Because LHCC revised its internal policy during our audit period to ensure that written notices of adverse determinations were sent to enrollees regardless of the enrollees' inpatient status, and because we did not identify any additional concerns after the effective date of t…

Findings
5
Recommendations
0
Open evidence record
Source status
Original source
Published
Mar 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Original document linked
Examines
Michigan

Selected Diabetes and Weight Loss Drugs Were Dispensed to Michigan Medicaid Managed Care Enrollees in Accordance With Federal and State Requirements

Because the State agency ensured, for the sample items we reviewed, that the MCOs followed all outpatient prescription drug coverage and utilization requirements that were in place during our audit period, including prior authorizations and quantity limits, this report contain…

Findings
2
Recommendations
1
Open evidence record
Source status
Original source
Published
Feb 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Source record
Original document linked
Examines
Missouri

Missouri Medicaid Rebates for Physician-Administered and Pharmacy Drugs

Although the State agency improved its controls over invoicing for rebates for physician-administered drugs, during our audit period the State agency did not comply with Federal Medicaid requirements for invoicing manufacturers for rebates for some physician-administered and p…

Findings
6
Recommendations
6
Open evidence record
Source status
Original source