Medicaid Audit Intelligence

Evidence record

Follow-Up Report on Prior Audit Recommendations Oversight and Encounter Claim Integrity of the Comprehensive Health Care Program

Jurisdiction
Michigan
Publishing agency
Michigan Office of the Auditor General
Publication date
September 9, 2022
Source record
Original document linked
Open original reportOriginal source available

Findings

2

Recommendations

2

Overall conclusion

MDHHS did not fully remediate Finding 1; a material condition still exists; Finding 2 was complied.

Scope

Follow-up of two material conditions from the May 2019 CHCP performance audit; generally covering June 1, 2021 through May 31, 2022.

Findings (2)

Each finding has a stable link.

  1. F-1126

    Monitoring of Medicaid Health Plan (MHP) encounter claim data and supporting medical records needed.

  2. F-1127

    Activation and development of certain CHAMPS edits needed.

Recommendations (2)

  1. R-988

    MDHHS implement a process to help ensure that MHP encounter claims are properly supported by medical records and accurately represent the medical services provided.

    Related finding F-1126
  2. R-989

    MDHHS activate and develop edits to identify and reject improper and duplicate encounter claims to help ensure the accuracy of capitation rates and the amount that the State pays to MHPs.

    Related finding F-1127