Estate Recovery Audit Report
Learn how the AI-generated research projects were createdOverall Conclusion
The division had adequate controls to ensure compliance with federal and state regulations and general information system controls were in place and functioning. However, outdated policies and procedures related to estate recovery led to inconsistent case processing and inadequate case follow-up, and the REC data controls require strengthening to prevent errors and omissions in the data.
Source Document
Audit Scope
Audit of the Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) Office of Legal and Regulatory Affairs, Estate Recovery, covering the period July 1, 2021 to November 1, 2024. The audit reviewed deceased Medicaid beneficiary cases closed between July 1, 2021 and November 20, 2023 that were subject to estate recovery statutes, during which $46.6 million was recovered from 1,399 estate recovery cases. The Recovery Unit tracks estate recovery cases and related payments using the Medicaid Recovery Tracking (REC) system, an Oracle-based in-house developed database. The audit also involved assessment of compliance with federal and state laws and internal criteria, and evaluation of general information system controls, including security management, change management, contingency planning, logical access security, and physical security and environmental controls, in accordance with the Statewide Information Security Manual (SISM).
Key Findings Summary
Inconsistencies in Case Processing: The Recovery Unit’s policies and procedures are not comprehensive or sufficiently updated, resulting in inconsistencies in case processing and inadequate case follow-up. Testing of 10 cases from 2,385 closed between July 1, 2021 and November 20, 2023 found 1 case (10%) with no evidence that information was verified or pote…
AI-Assisted
AI Scope Summary
Assess the adequacy of internal controls for estate recovery and the reliability of the Medicaid Recovery Tracking data and IT controls to ensure compliant and effective estate recovery activities.
AI-Generated Insight
The audit underscores governance gaps between estate recovery operations, data integrity in the REC system, and information security practices. Addressing outdated procedures and strengthening data reliability are essential to safeguard recoveries, ensure regulatory compliance, and protect sensitive information.