Medicaid Audit Intelligence

Public audit ledger

Medicaid audit reports

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Evidence register

154 reports

Published
Jul 2026
Jurisdiction
Arizona
Publishing agency
Centers for Medicare and Medicaid Services
Report ID
REPORT 169

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
Jul 16, 2026
Jurisdiction
New York
Publishing agency
Office of the New York State Comptroller Division of State Government Accountability
Report ID
REPORT 173

Medicaid Program – Improper Payments for Laboratory and Related Services

DOH did not provide adequate guidance to providers and MCOs, nor did it effectively monitor fee-for-service and managed care claims to ensure Medicaid paid only for necessary laboratory services. Weaknesses in DOH’s eMedNY system edits allowed improper fee-for-service laborato…

Findings
1
Recommendations
8
Open evidence record
Source status
Original source
Published
Jun 2026
Jurisdiction
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Report ID
REPORT 163

Inaccurate Medicaid Managed Care Network Lists May Compromise State Oversight of Access to Maternal Health Care

We found that the network lists from Centene, Elevance, and UnitedHealthcare Medicaid plans in five States contained inaccuracies—potential ghost providers who reported not being in-network, incorrect contact information, and discrepancies with online provider directories—that…

Findings
3
Recommendations
2
Open evidence record
Source status
Original source
Published
Jun 2026
Jurisdiction
North Dakota
Publishing agency
U.S. Department of Health and Human Services Office of Inspector General
Report ID
REPORT 165

North Dakota Could Better Ensure That Providers Fully Comply With Federal Waiver and State Health, Safety, and Administrative Requirements at 44 Residential Settings

The North Dakota State agency could improve oversight of residential providers and settings to better ensure the health and safety of participants with intellectual and developmental disabilities residing in residential habilitation settings; weaknesses in the quality manageme…

Findings
7
Recommendations
3
Open evidence record
Source status
Original source
Published
Jun 2026
Jurisdiction
Pennsylvania
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 161

Medicaid Managed Care Behavioral Health Service Denials in Philadelphia by Community Behavioral Health

CBH did not comply with Federal and State requirements for denying prior-authorization behavioral health services; none of the 100 sampled denials complied with all applicable requirements, indicating potential systemic issues in denials and potential impact on enrollee rights.

Findings
5
Recommendations
6
Open evidence record
Source status
Original source
Published
Jun 2026
Jurisdiction
Federal
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 164

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
Published
Jun 2026
Jurisdiction
Federal
Publishing agency
U.S. Department of Health and Human Services Office of Inspector General
Report ID
REPORT 160

CMS Should Improve Its Policies and Procedures for the Oversight of States’ Reported Medicaid Expenditures to Better Protect the Financial Integrity of the Medicaid Program

CMS did not consistently follow its policies and procedures for overseeing States’ CMS-64 expenditures and its processes for deferred payments and disallowed expenditures require improvements to protect Medicaid financial integrity.

Findings
3
Recommendations
4
Open evidence record
Source status
Original source
Published
Jun 2026
Jurisdiction
California
Publishing agency
U.S. Department of Health and Human Services Office of Inspector General
Report ID
REPORT 162

California's Medicaid Reimbursements for Clinical Diagnostic Laboratory Services

The State agency did not always claim Federal Medicaid reimbursement for clinical diagnostic laboratory services in accordance with Federal and State requirements, resulting in overpayments totaling $13.9 million (Federal share) and potentially $29.3 million (Federal share not…

Findings
4
Recommendations
4
Open evidence record
Source status
Original source
Published
Jun 4, 2026
Jurisdiction
New York
Publishing agency
Office of the New York State Comptroller, Division of State Government Accountability
Report ID
REPORT 174

Oversight of Services for Medicaid Members Enrolled in Clinical Trials

DOH did not always receive attestation forms prior to members participating in clinical trials, and a limited number of improper Medicaid payments related to investigational services or services not covered by the member’s MCO or lacking prior authorization were identified. DO…

Findings
4
Recommendations
3
Open evidence record
Source status
Original source
Published
May 21, 2026
Jurisdiction
Georgia
Publishing agency
Myers and Stauffer LC
Report ID
REPORT 170

Comparison of Georgia Care Management Organization Encounter Data to Cash Disbursements for Amerigroup Community Care

The engagement is framed as a consulting study not an audit, with findings indicating that most reconciliation totals align closely to CDJs while highlighting notable data quality issues that affect GF 360 completion percentages and several delegated vendor categories. While s…

Findings
6
Recommendations
8
Open evidence record
Source status
Original source
Published
Mar 2026
Jurisdiction
Federal
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 159

Medicaid Managed Care Behavioral Health Services Denials in Louisiana

Because LHCC revised its internal policy during our audit period to ensure that written notices of adverse determinations were sent to enrollees regardless of the enrollees' inpatient status, and because we did not identify any additional concerns after the effective date of t…

Findings
5
Recommendations
0
Open evidence record
Source status
Original source
Published
Mar 2026
Jurisdiction
Michigan
Publishing agency
U.S. Department of Health and Human Services Office of Inspector General
Report ID
REPORT 158

Selected Diabetes and Weight Loss Drugs Were Dispensed to Michigan Medicaid Managed Care Enrollees in Accordance With Federal and State Requirements

Because the State agency ensured, for the sample items we reviewed, that the MCOs followed all outpatient prescription drug coverage and utilization requirements that were in place during our audit period, including prior authorizations and quantity limits, this report contain…

Findings
2
Recommendations
1
Open evidence record
Source status
Original source
Published
Mar 17, 2026
Jurisdiction
Minnesota
Publishing agency
Office of the Legislative Auditor, Minnesota
Report ID
REPORT 130

Department of Human Services Investigations of Alleged Kickbacks in the Early Intensive Developmental and Behavioral Intervention Program

DHS has long-standing authority to impose sanctions for kickbacks under federal SSA provisions and state law; however, a decades-old error in DHS's administrative rules defining fraud and ambiguous suspension authority limited action on kickbacks alone. The 2025 legislative ch…

Findings
8
Recommendations
3
Open evidence record
Source status
Original source
Published
Feb 2026
Jurisdiction
Missouri
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 156

Missouri Medicaid Rebates for Physician-Administered and Pharmacy Drugs

Although the State agency improved its controls over invoicing for rebates for physician-administered drugs, during our audit period the State agency did not comply with Federal Medicaid requirements for invoicing manufacturers for rebates for some physician-administered and p…

Findings
6
Recommendations
6
Open evidence record
Source status
Original source
Published
Feb 2026
Jurisdiction
Colorado
Publishing agency
Department of Health and Human Services Office of Inspector General Office of Audit Services
Report ID
REPORT 157

Colorado Made at Least $77.8 Million in Improper Fee-for-Service Medicaid Payments for Applied Behavior Analysis Provided to Children

Colorado’s FFS Medicaid payments for Applied Behavior Analysis provided to children did not fully comply with Federal and State requirements, resulting in improper and potentially improper payments and highlighting a need for stronger governance, oversight, and guidance to pre…

Findings
7
Recommendations
5
Open evidence record
Source status
Original source
Published
Feb 2026
Jurisdiction
West Virginia
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 155

West Virginia Medicaid Managed-Care Rebates Associated With Physician-Administered Drugs

The Office of Inspector General found that West Virginia did not invoice manufacturers for some rebates due on physician-administered drugs dispensed to enrollees of Medicaid managed-care organizations during the audit period, totaling $8.2 million ($6.1 million Federal share)…

Findings
3
Recommendations
2
Open evidence record
Source status
Original source
Published
Feb 20, 2026
Jurisdiction
Texas
Publishing agency
Texas Health and Human Services Office of Inspector General
Report ID
REPORT 141

Dental Value-Added Services—Molina Healthcare

Molina did not consistently submit dental value-added services encounters with the correct financial arrangement code, which may affect the accuracy of FSR data and the computation of capitation rates and potential experience rebates.

Findings
1
Recommendations
5
Open evidence record
Source status
Original source
Published
Feb 20, 2026
Jurisdiction
Texas
Publishing agency
Texas Health and Human Services Commission Office of Inspector General
Report ID
REPORT 140

Dental Value-Added Services—Wellpoint

Wellpoint did not consistently submit dental value-added services encounters with the correct financial arrangement code.

Findings
1
Recommendations
6
Open evidence record
Source status
Original source
Published
Jan 2026
Jurisdiction
Maine
Publishing agency
United States Department of Health and Human Services Office of Inspector General Office of Audit Services
Report ID
REPORT 154

Maine Made at Least $45.6 Million in Improper Fee-for-Service Medicaid Payments for Rehabilitative and Community Support Services Provided to Children Diagnosed With Autism

For our audit period, the Maine Department of Health and Human Services’s FFS Medicaid payments for rehabilitative and community support services provided to children diagnosed with autism included improper and potentially improper payments. Improper payments totaled at least…

Findings
7
Recommendations
4
Open evidence record
Source status
Original source
Published
Jan 30, 2026
Jurisdiction
Texas
Publishing agency
Texas Health and Human Services Office of Inspector General Audit and Inspections Division
Report ID
REPORT 132

Follow-Up Assessment on a Previously Published Audit Report Managed Care Pharmacy Claims Paid to Encore Pharmacy #1

Based on our assessment, Encore Pharmacy #1 fully resolved all reported audit issues. As a result, OIG Audit did not reissue any recommendations from the previous audit.

Findings
2
Recommendations
0
Open evidence record
Source status
Original source
Published
Jan 30, 2026
Jurisdiction
Texas
Publishing agency
Texas Health and Human Services Office of Inspector General
Report ID
REPORT 131

Special Investigative Unit – Blue Cross and Blue Shield

The Blue Cross and Blue Shield of Texas Special Investigative Unit did not operate an effective SIU program and did not comply with requirements related to preventing, detecting, and investigating fraud, waste, and abuse, and reporting accurate information on SIU activities, r…

Findings
10
Recommendations
8
Open evidence record
Source status
Original source