Medicaid audit reports
Browse every indexed Medicaid audit report. Each listing links to a crawlable detail page with conclusions, findings, recommendations, and the original public source document.
Medicaid Agencies Made Millions in Unallowable Capitation Payments to Managed Care Organizations on Behalf of Deceased Enrollees
We estimate that Medicaid agencies made $207,501,380 ($138,645,710 Federal share) in unallowable capitation payments to MCOs for deceased enrollees during the audit period (July 1, 2021 – June 30, 202...
Illinois Medicaid Managed Care Capitation Payments for Incarcerated Enrollees
The audit determined that Illinois made unallowable managed care capitation payments for incarcerated enrollees during the audit period, totaling at least $9.5 million with $8.3 million Federal share,...
Review of Durable Medical Equipment Providers
MassHealth did not fully ensure that DME was not ordered by excluded providers or for deceased members, as evidenced by three identified findings and associated overpayments; ongoing post-payment and ...
Medicaid Program: Oversight of Managed Care Provider Networks
DOH did not maintain sufficient oversight of Medicaid managed care provider networks during 2023, with data reliability and process control issues affecting the accuracy of deficiency reporting and SO...
A Performance Audit of the Office of Inspector General of Medicaid Services: Policy Options for Improved Governance and Medicaid Oversight
The report concludes that Utah’s OIG has not adequately fulfilled its Medicaid oversight mandate and suffers from governance, reporting, and performance weaknesses, with risk-based planning and proact...
How Kentucky Failed to Prevent Over $800 Million of Medicaid Waste
Concurrent capitation payments across state lines resulted in substantial waste (over $800 million) during 2019–2022 due to gaps in residency determination, PARIS/T-MSIS data usage, and contract oblig...
Medicaid Program: Improper Premium Payments Made on Behalf of Managed Care Members Residing Outside the State
None
Washington Medicaid Managed Care Medical Loss Ratio Audit
CMS identified eight findings requiring correction, but none resulted in an MLR recalculation below the 85% remittance threshold; the audit identified operational improvements and oversight enhancemen...
Medicaid Payments to MCOs for Deceased Individuals
The DHHS procedures for identifying deaths, updating records, and recouping post-death Medicaid payments were found to be insufficient to prevent improper disbursements to MCOs. While some adjustments...
Performance Audit Report July 2025 Medicaid Provider Enrollment Follow-Up Audit
The Division of Health Benefits did not fully implement prior audit recommendations during 2023, leaving ongoing risks to patient safety and Medicaid integrity from providers with suspended licenses, ...
Pennsylvania Capitation Payments for Enrollees With Multiple Medicaid Identification Numbers
The OIG concluded that Pennsylvania made unallowable capitation payments totaling at least $8,784,549 ($4,596,390 Federal share) for enrollees with multiple Medicaid ID numbers during the audit period...
Wisconsin’s Fee-for-Service Medicaid Payments for Applied Behavior Analysis
The Wisconsin Department of Health Services’ ForwardHealth program did not provide adequate oversight of FFS Medicaid ABA payments, resulting in improper and potentially improper payments for autism-r...
Analysis of Selected Nursing Facilities’ Use of Medicaid Reimbursement for Direct Care Compensation
The data brief concludes that there is no clear, positive correlation between higher direct care compensation and higher nursing hours per resident day (HPRD). Increases in direct care compensation ar...
Ohio Medicaid Managed Care Medical Loss Ratio Audit
While no remittances were required based on the findings, the audit identified multiple areas for improvement in Ohio’s oversight and reporting processes to ensure compliance with federal requirements...
Performance Audit of Medicaid Eligibility Determinations for Long-Term Care
The audit identified significant delays, data inaccuracies, and reporting deficiencies in Illinois' Medicaid long-term care eligibility process. While some system enhancements have been implemented, i...
Medicaid Managed Care Improper Payment Estimate
The GAO report highlights that while CMS's current improper payment estimates for Medicaid managed care are near zero, they do not capture all program integrity risks. CMS has taken steps to improve o...
Medicaid Program: Claims Processing Activity April 1, 2024 Through September 30, 2024
The audit concluded that eMedNY reasonably ensured Medicaid claims were submitted by approved providers, processed in accordance with Medicaid requirements, and paid correctly overall. However, improv...
Maryland Did Not Comply With Federal Waiver and State Requirements at 20 Adult Day Care Facilities Audited
The Maryland Department of Health did not fully comply with Federal waiver and State requirements in overseeing adult day care facilities; 253 noncompliance instances were identified across health and...
Oklahoma Focused Program Integrity Review Final Report
CMS supports Oklahoma’s efforts and encourages further improvements in program integrity. The review identified four observations for the state’s attention but no non-compliance findings that pose a r...
Audit Of Ohio Adult Day Health Care Services
The Ohio Department of Medicaid did not fully comply with Federal waiver and State requirements in overseeing providers serving adults in the ADS program; inspections were insufficient to ensure a con...
School-Based Fee-for-Service Medicaid Reimbursements
The audit identifies widespread weaknesses in Kansas’s school-based Medicaid FFS program, including policy misalignments with federal guidance, documentation gaps, and data integrity issues that contr...
North Carolina’s Medicaid Control Environment, Risk Management Practices, and Governing Processes Were Assessed as Moderate Risk
Overall, the audit determined that North Carolina's Medicaid control environment, risk management practices, and governing processes operate at a moderate risk level, with three risk areas rated high ...
Texas Did Not Fully Comply With Federal Waiver And State Health, Safety, And Administrative Requirements At All 20 Adult Day Activity And Health Service Facilities Audited
The State agency did not fully comply with Federal waiver and State requirements in overseeing DAHS facilities serving people with special health care needs, and its inspections were not sufficient to...