Evidence record
Medicaid Program Integrity Examining the Health Care Authority’s oversight of efforts at state agencies
- Jurisdiction
- Washington
- Publishing agency
- Office of the Washington State Auditor
- Publication date
- July 8, 2021
- Source record
- Original document linked
Findings
4
Recommendations
3
Overall conclusion
Medicaid is a significant public assistance program in Washington, requiring robust program integrity efforts to ensure proper use of funds. While HCA has taken steps to improve oversight, there are opportunities to strengthen strategic planning, performance measurement, and oversight of sister agencies and MCOs. Implementing recommended improvements will help ensure Medicaid funds are used effectively and fraud is minimized.
Scope
The audit examines Washington State's Medicaid program, including oversight of efforts at the Health Care Authority (HCA), sister agencies such as the Department of Social and Health Services and the Department of Children, Youth, and Families, and managed care organizations (MCOs). It covers activities and oversight responsibilities from 2015 through 2021, focusing on program integrity efforts, strategic planning, performance measurement, and compliance with federal requirements.
Findings (4)
Each finding has a stable link.
- F-160
HCA has created a Division of Program Integrity but can improve oversight through strategic planning and performance measurement.
- F-161
HCA has not provided federally required oversight of Medicaid program integrity efforts at sister state agencies.
- F-162
The Division has expanded efforts with MCOs but can do more to reduce fraud and improper payments.
- F-163
Improvements to audit selection practices are needed to prioritize high-risk cases and meet federal requirements.