Oklahoma Focused Program Integrity Review Final Report
Learn how the AI-generated research projects were createdOverall Conclusion
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 risk.
Source Document
Audit Scope
The review assessed Oklahoma’s Medicaid Personal Care Services (PCS) program for Fiscal Years 2020 – 2022, focusing on program integrity oversight, compliance with CMS regulations, EVV implementation, provider enrollment, self-directed services, agency-based provider oversight, and staff credentialing.
Key Findings Summary
No findings that create a risk to the Oklahoma Medicaid program related to PCS program integrity oversight.
AI-Assisted
AI Scope Summary
The audit aimed to evaluate Oklahoma's Medicaid Personal Care Services program integrity oversight, compliance with federal regulations, and to provide recommendations for strengthening fraud detection, provider oversight, and inter-agency collaboration.
AI-Generated Insight
The report highlights Oklahoma's efforts in managing Medicaid PCS with a focus on oversight, fraud prevention, and compliance, while identifying opportunities for enhanced collaboration, training, and data analytics to strengthen program integrity.
Audit Objectives
To assess Oklahoma’s Medicaid Personal Care Services (PCS) program integrity oversight efforts for Fiscal Years 2020 – 2022.
To evaluate the state’s compliance with CMS regulatory PCS requirements within 42 CFR Parts 440 and 441.
To provide the state with feedback, technical assistance, and educational resources to enhance program integrity.
Audit Findings (1)
No findings that create a risk to the Oklahoma Medicaid program related to PCS program integrity oversight.
Recommendations (5)
Develop and implement procedures to improve communication and collaboration between the Oklahoma Health Care Authority (OHCA) and the Oklahoma Department of Human Services (OKDHS).
Provide PCS agencies with additional training and guidance to monitor and report potential EVV fraud.
Assign a unique identifier or NPI for agency-based PCAs to facilitate tracking.
Implement additional program integrity efforts, including data analytics, to increase suspected fraud referrals to the Medicaid Fraud Control Unit (MFCU).
Provide additional training to PCS provider agencies on referral and reporting of suspected fraud, waste, and abuse.