Medicaid Audit Intelligence

Public audit ledger

Medicaid audit reports

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Evidence register

188 reports

Published
Oct 15, 2026
Jurisdiction
California
Publishing agency
California State Auditor
Report ID
REPORT 208

State High-Risk Program Assessment of Department of Health Care Services Oversight of Medi-Cal Provider Payments

The California State Auditor concludes that Health Care Services’ oversight of Medi-Cal provider payments is at substantial risk of fraud, waste, or abuse due to inadequate follow-up on high-risk providers, ongoing participation of ineligible providers, and significant ground-…

Findings
10
Recommendations
0
Open evidence record
Source status
Original source
Published
Oct 2, 2026
Jurisdiction
South Carolina
Publishing agency
U.S. Department of Health and Human Services Office of Inspector General
Report ID
REPORT 206

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
Jurisdiction
South Carolina
Publishing agency
Department of Health and Human Services, Office of Inspector General, Office of Audit Services
Report ID
REPORT 198

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
Jurisdiction
Federal
Publishing agency
Centers for Medicare & Medicaid Services
Report ID
REPORT 211

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
Jurisdiction
Alabama
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 195

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 2026
Jurisdiction
Tennessee
Publishing agency
Office of Inspector General, Department of Health and Human Services
Report ID
REPORT 200

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
Jurisdiction
Federal
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 197

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
Jurisdiction
New York
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General, Office of Audit Services
Report ID
REPORT 210

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
Jurisdiction
Georgia
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 209

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 30, 2026
Jurisdiction
Wisconsin
Publishing agency
U.S. Department of Health and Human Services Office of Inspector General
Report ID
REPORT 207

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
Jurisdiction
Georgia
Publishing agency
U.S. Department of Health and Human Services Office of Inspector General
Report ID
REPORT 203

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 23, 2026
Jurisdiction
Tennessee
Publishing agency
U.S. Department of Health and Human Services Office of Inspector General
Report ID
REPORT 202

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 21, 2026
Jurisdiction
New York
Publishing agency
U.S. Department of Health and Human Services Office of Inspector General
Report ID
REPORT 204

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 3, 2026
Jurisdiction
California
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 188

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 1, 2026
Jurisdiction
Ohio
Publishing agency
Auditor of State of Ohio
Report ID
REPORT 193

CarePlus Home Healthcare LLC Compliance Examination

This metadata-only extract notes a compliance examination of a Medicaid provider in Ohio for the 2021–2023 period. The provided text lacks detailed findings or conclusions, so a complete assessment will require the full report content.

Findings
0
Recommendations
0
Open evidence record
Source status
Original source
Published
Sep 1, 2026
Jurisdiction
Ohio
Publishing agency
Ohio Auditor of State
Report ID
REPORT 194

Compliance Examination of New Destiny Treatment Center, Inc.

The Ohio Auditor of State's Compliance Examination of New Destiny Treatment Center, Inc. assesses Medicaid program compliance and internal controls for 2021-2023, with attention to billing accuracy, documentation, and program integrity to inform corrective actions and future a…

Findings
0
Recommendations
0
Open evidence record
Source status
Original source
Published
Aug 2026
Jurisdiction
North Dakota
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 178

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
Jurisdiction
Arizona
Publishing agency
U.S. Department of Health and Human Services Office of Inspector General
Report ID
REPORT 180

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