Maryland Department of Health – Medical Care Programs Administration Audit
Learn how the AI-generated research projects were createdOverall Conclusion
The audit concluded that the Maryland Department of Health’s Medical Care Programs Administration (MCPA) had an unsatisfactory level of accountability and compliance under the audit rating system, with multiple significant findings related to third-party liability interfaces, improper payments, eligibility processing, provider oversight, and contract monitoring. The status report indicates ongoing corrective actions with targeted completion between mid-2024 and mid-2025 for non-cybersecurity findings, while cybersecurity findings were redacted in the public copy. OLA will reassess follow-up viability in August 2024 based on MDH implementation status.
Source Document
Audit Scope
Original audit scope covered MDH's Medical Care Programs Administration for the period August 1, 2018 to March 31, 2022, focusing on program integrity, third-party liability interfacing, eligibility processing, and provider audits. The status update as of April 12, 2024 discusses the ongoing implementation of corrective actions for the eight non-cybersecurity findings and redacted cybersecurity-related findings; a follow-up review is not being pursued immediately but an updated status report is expected in August 2024 to determine the practicality of a follow-up.
Key Findings Summary
Finding 10: Redacted cybersecurity-related finding.
Finding 5: MCPA did not monitor the utilization control agent contractor to ensure continued stay reviews of Medicaid recipients in nursing facilities were performed timely.
Finding 1: The Medical Care Programs Administration (MCPA) did not ensure that all referrals of potential third-party health insurance information were investigated and recorded in the Medicaid Management Information System (MMIS II), potentially resulting in improper payments.
View the Findings tab to see all 10 findings
AI-Assisted
AI Scope Summary
Assess the MDH MCPA’s accountability and compliance, evaluate the status of corrective actions for prior unsatisfactory findings, and identify ongoing weaknesses in third-party liability interfacing, eligibility processing, provider audits, and program integrity to inform follow-up oversight.
AI-Generated Insight
This report highlights persistent gaps in program integrity and data governance within Maryland's Medicaid operations, especially around third-party liability interfacing with MMIS II, timely eligibility updates, and monitoring of providers and contractors. The agency has initiated corrective actions, including staffing augmentations, new agreements (e.g., Nurse Monitoring Agreement), and planned UCA and ventilator-audit processes, and is pursuing a modular MMIS to enable better prevention and recovery of improper payments. The public copy's cybersecurity redactions underscore ongoing sensitivity around security incidents but also indicate broader governance improvements are needed. The findings justify targeted, auditable actions and a structured follow-up cadence (August 2024 and beyond) to safeguard program dollars and ensure compliance with Maryland laws and regulations.