Medicaid Audit Intelligence

Publishing agency

Oregon Secretary of State, Audits Division

Reports attributed to this exact publisher identity in the indexed source metadata.

Evidence register

4 reports

Published
Oct 2024
Jurisdiction
Oregon
Publishing agency
Oregon Secretary of State, Audits Division
Report ID
REPORT 87

The Oregon Eligibility System Appropriately Determines Eligibility, But Input Errors Continue to Occur

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…

Findings
6
Recommendations
3
Open evidence record
Source status
Original source
Published
Oct 18, 2024
Jurisdiction
Oregon
Publishing agency
Oregon Secretary of State, Audits Division
Report ID
REPORT 91

Without Federal Action, States Will Continue to Pay Millions of Dollars in Duplicate Medicaid Payments

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.

Findings
9
Recommendations
7
Open evidence record
Source status
Original source
Published
Aug 2023
Jurisdiction
Oregon
Publishing agency
Oregon Secretary of State, Audits Division
Report ID
REPORT 100

Poor Accountability and Transparency Harm Medicaid Patients and Independent Pharmacies

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,…

Findings
4
Recommendations
9
Open evidence record
Source status
Original source
Published
Dec 8, 2021
Jurisdiction
Oregon
Publishing agency
Oregon Secretary of State, Audits Division
Report ID
REPORT 102

Timely Notification of Inpatient Hospital Stays Could Help Reduce Improper Medicaid Payments

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…

Findings
5
Recommendations
2
Open evidence record
Source status
Original source