Medicaid Audit Intelligence

US · Publishing authority

Federal Medicaid audit evidence

Reports published or commissioned by federal oversight authorities. A report may examine one jurisdiction, several jurisdictions, or a nationwide program.

Evidence register

71 reports

Published
Oct 2, 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services Office of Inspector General
Report ID
REPORT 206
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

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 approximately $108.6 million; four recommendations were issued to CMS and th…

Findings
2
Recommendations
4
Open evidence record
Source status
Original source
Published
Sep 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General, Office of Audit Services
Report ID
REPORT 210
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
Original source
Published
Sep 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
Department of Health and Human Services, Office of Inspector General, Office of Audit Services
Report ID
REPORT 198
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 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
Department of Health and Human Services Office of Inspector General Office of Audit Services
Report ID
REPORT 199
Examines
Wisconsin

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

The State agency may have improperly claimed an estimated $454.9 million in Federal reimbursement through its Medicaid school-based program.

Findings
3
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
Report ID
REPORT 196
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
Original source
Published
Sep 2026
Scope
National
Source authority
Federal
Publishing agency
Centers for Medicare & Medicaid Services
Report ID
REPORT 211
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
Original source
Published
Sep 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
Office of Inspector General, Department of Health and Human Services
Report ID
REPORT 200
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
National
Source authority
Federal
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 197
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
Original source
Published
Sep 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 209
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
Original source
Published
Sep 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 195
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
Original source
Published
Sep 30, 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services Office of Inspector General
Report ID
REPORT 207
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 23, 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services Office of Inspector General
Report ID
REPORT 202
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

Tennessee claimed Federal Medicaid reimbursement for some TCM services during the audit period that did not comply with Federal and State requirements.

Findings
4
Recommendations
2
Open evidence record
Source status
Original source
Published
Sep 23, 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services Office of Inspector General
Report ID
REPORT 203
Examines
Georgia

Georgia Medicaid Fraud Control Unit: 2024 Onsite Inspection

This evaluation of the Georgia Medicaid Fraud Control Unit’s 2024 onsite inspection identified six open, unimplemented recommendations aimed at strengthening personnel practices, fraud referrals, supervisory documentation, reporting of convictions/adverse actions to federal pa…

Findings
0
Recommendations
6
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
Report ID
REPORT 204
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
Sep 21, 2026
Scope
National
Source authority
Federal
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 205
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 3, 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 188
Examines
California

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

California did not report and return all Medicaid overpayments identified by its Medicaid Fraud Control Unit; these unreported amounts totaling hundreds of millions of dollars indicate deficiencies in reporting and coordination with the MFCU, requiring action to report and ret…

Findings
4
Recommendations
4
Open evidence record
Source status
Original source
Published
Sep 2, 2026
Scope
National
Source authority
Federal
Publishing agency
Centers for Medicare and Medicaid Services
Report ID
REPORT 190
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
Aug 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 178
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 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
U.S. Department of Health and Human Services Office of Inspector General
Report ID
REPORT 180
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 13, 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 177
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
Report ID
REPORT 176
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
Jul 2026
Scope
Single jurisdiction
Source authority
Federal
Publishing agency
Centers for Medicare and Medicaid Services
Report ID
REPORT 169
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
Jun 2026
Scope
Multi-jurisdiction
Source authority
Federal
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 164
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