Evidence record
Oklahoma Focused Program Integrity Review Final Report
- Jurisdiction
- Ohio
- Publishing agency
- Centers for Medicare & Medicaid Services
- Publication date
- May 30, 2025
- Source record
- Original document linked
Findings
1
Recommendations
5
Overall conclusion
CMS supports Oklahoma’s efforts and encourages further improvements in program integrity. The review identified four observations for the state’s attention but no non-compliance findings that pose a risk.
Scope
The review assessed Oklahoma’s Medicaid Personal Care Services (PCS) program for Fiscal Years 2020 – 2022, focusing on program integrity oversight, compliance with CMS regulations, EVV implementation, provider enrollment, self-directed services, agency-based provider oversight, and staff credentialing.
Findings (1)
Each finding has a stable link.
- F-045
No findings that create a risk to the Oklahoma Medicaid program related to PCS program integrity oversight.
Recommendations (5)
- R-058
Develop and implement procedures to improve communication and collaboration between the Oklahoma Health Care Authority (OHCA) and the Oklahoma Department of Human Services (OKDHS).
- R-059
Provide PCS agencies with additional training and guidance to monitor and report potential EVV fraud.
- R-060
Assign a unique identifier or NPI for agency-based PCAs to facilitate tracking.
- R-061
Implement additional program integrity efforts, including data analytics, to increase suspected fraud referrals to the Medicaid Fraud Control Unit (MFCU).
- R-062
Provide additional training to PCS provider agencies on referral and reporting of suspected fraud, waste, and abuse.