Publishing agency
Reports attributed to this canonical publisher identity in the public audit registry.
5 reports
OHA agreed with all recommendations.
The audit found that the ONE system largely determines eligibility accurately for Medical and SNAP programs, and automated eligibility determinations are generally effective. However, input errors, manual data entry, and inconsistent override monitoring create risk for incorre…
The audit concludes that without federal action, states will continue to pay millions of dollars in duplicate Medicaid payments; stronger data sharing and real-time enrollment data are needed; Do Not Pay and improved PARIS controls could reduce improper payments.
The audit identifies Oregon’s Medicaid PBM framework as overly complex and insufficiently transparent, with limited direct oversight of PBMs by OHA. The report recommends a shift toward stronger patient and pharmacy protections, uniform formularies, fiduciary duties for PBMs,…
OHA lacks timely notification of inpatient hospital stays, which results in some claims being paid for services not provided because the Medicaid client was in the hospital; there is significant improper payments and high-risk claims related to in-home services, NEMT, and priv…