Without Federal Action, States Will Continue to Pay Millions of Dollars in Duplicate Medicaid Payments
Learn how the AI-generated research projects were createdOverall Conclusion
The audit concludes that without federal action, states will continue to pay millions of dollars in duplicate Medicaid payments; stronger data sharing and real-time enrollment data are needed; Do Not Pay and improved PARIS controls could reduce improper payments.
Source Document
Audit Scope
Audit covers concurrent capitation payments made to Oregon’s Coordinated Care Organizations (CCOs) and Washington managed care entities from January 1, 2019, to December 31, 2022, focusing on identifying Medicaid recipients enrolled in multiple states concurrently. The audit collaborated with HHS-OIG and the Washington State Auditor; included testing of a joint Oregon-Washington sample; analyzed PARIS data quality and timeliness; evaluated the Do Not Pay program; and assessed internal controls of the Office of Payment Accuracy and Recovery (OPAR) and related agencies.
Key Findings Summary
HHS-OIG testing found 49% of months tested for Washington recipients were improper (490 of 997 months).
For testing involving six other states, 417 months across 30 recipients showed an average improper months rate of 30%.
There are inherent challenges in residency determination for unhoused individuals and frequent movers, increasing risk of duplicate enrollment.
View the Findings tab to see all 9 findings
AI-Assisted
AI Scope Summary
Assess whether the Oregon Health Authority can improve identification of Medicaid recipients receiving benefits in multiple states concurrently and identify opportunities for reducing duplicate capitation payments through state and federal data sharing and process improvements.
AI-Generated Insight
This audit highlights significant gaps in inter-state visibility of Medicaid enrollment data and the resulting financial waste from concurrent enrollment. It shows how federal data-sharing (PARIS timing, CMS access) and tools like Do Not Pay can curb improper payments, but federal action is essential for real-time data access and proactive prevention.