Evidence record
Oregon Health Authority: Medicaid Duplicate IDs Put Federal Funding at Risk
- Jurisdiction
- Oregon
- Publishing agency
- Oregon Secretary of State, Audits Division
- Audit organization
- Oregon Secretary of State Audits Division
- Publication date
- September 2026
- Source record
- Original document linked
Findings
4
Recommendations
5
Overall conclusion
OHA agreed with all recommendations.
Scope
This audit focuses on Medicaid recipients who had multiple system IDs and concurrent capitation payments made from 2020 to 2024. A capitation payment is a fixed monthly amount OHA pays to Coordinated Care Organizations (CCOs) for each recipient regardless of how many services a recipient uses.
Findings (4)
Each finding has a stable link.
- F-1408
Federal funding could be at risk if OHA does not follow federal rules.
- F-1409
OHA made duplicate capitation payments for the same recipient during the same time.
- F-1410
We performed data matches between all Medicaid recipients from 2020 to 2024 to identify potential duplicate recipients where capitation payments were made concurrently.
- F-1411
Testing identified $230,252 in overpayments; projections estimate OHA made between $232,000 and $4.1 million of duplicate capitation payments for the entire Medicaid program between 2020 and 2024.
Recommendations (5)
- R-1259
Review the other IDs that were not detail tested to determine if they are duplicates and whether overpayments occurred, and remit the federal portion of the overpayments back to the federal government.
Related finding F-1411 - R-1260
Recoup duplicate payments from Coordinated Care Organizations using the capitation reconciliation process.
Related finding F-1409 - R-1261
Provide specific training to eligibility workers on best practices for researching applicants and potential matches.
Related finding F-1410 - R-1262
Develop future system enhancements that will reduce the manual research currently performed by eligibility workers.
Related finding F-1410 - R-1263
Design and implement a quality control process to better prevent and detect duplicate IDs, including a mechanism to identify capitation payments once duplicate IDs are identified, and using the established capitation reconciliation process to remit the federal portion of overpayments in compliance with federal regulations.
Related finding F-1410