Public audit ledger
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188 reports
This Public Interest Report, released August 27, 2026, concerns the Ohio Public Benefit Programs with a reporting period of November 1–30, 2025. The provided text lacks explicit audit objectives, findings, or conclusions, suggesting that the accessible excerpt may be a portal…
The public interest audit identifies gaps in eligibility verification within Medicaid, with 10% of sampled recipients lacking verified citizenship, suggesting the need for standardized processes and better interagency data sharing; other programs performed better.
The audit identified significant deficiencies in internal controls over AD Waiver payments, EVV verification, and related processes, resulting in observable overpayments and the risk of continued improper payments. The Department has implemented some corrective controls (e.g.,…
Overall, the state is well-positioned to execute swift corrective action and rectify identified control weaknesses and baseline data issues without delay, leveraging its existing framework to streamline cross-program integration.
Kansas did not ensure that its Medicaid MCOs complied with MH/SUD parity requirements related to prior authorization for MH/SUD services for calendar year 2023, and deficiencies in parity analyses, data quality, and state oversight indicate potential barriers to access for MH/…
New York did not ensure that all three selected Medicaid managed care organizations complied with MH/SUD parity requirements related to prior authorization.
While the audit identified areas for improvement in reporting consistency and oversight, Arizona’s Medicaid Managed Care Plans demonstrated MLR performance above the federal minimum threshold during the audit period. Implementing the recommendations will improve data integrity…
DOH did not provide adequate guidance to providers and MCOs, nor did it effectively monitor fee-for-service and managed care claims to ensure Medicaid paid only for necessary laboratory services. Weaknesses in DOH’s eMedNY system edits allowed improper fee-for-service laborato…
In our opinion, except for the material noncompliance with the specified requirements described in the accompanying Schedule of Findings as items 2025-001 and 2025-002, the Department complied with the specified requirements during the two years ended June 30, 2025, in all mat…
CMS did not consistently follow its policies and procedures for overseeing States’ CMS-64 expenditures and its processes for deferred payments and disallowed expenditures require improvements to protect Medicaid financial integrity.
We found that the network lists from Centene, Elevance, and UnitedHealthcare Medicaid plans in five States contained inaccuracies—potential ghost providers who reported not being in-network, incorrect contact information, and discrepancies with online provider directories—that…
The North Dakota State agency could improve oversight of residential providers and settings to better ensure the health and safety of participants with intellectual and developmental disabilities residing in residential habilitation settings; weaknesses in the quality manageme…
The State agency did not always claim Federal Medicaid reimbursement for clinical diagnostic laboratory services in accordance with Federal and State requirements, resulting in overpayments totaling $13.9 million (Federal share) and potentially $29.3 million (Federal share not…
CBH did not comply with Federal and State requirements for denying prior-authorization behavioral health services; none of the 100 sampled denials complied with all applicable requirements, indicating potential systemic issues in denials and potential impact on enrollee rights.
Online provider directories of Centene, Elevance, and UnitedHealthcare Medicaid plans in five States contained inaccuracies (ghost providers, missing in-network providers, and incorrect contact information) that may impede enrollees' access to maternal health care and distort…
DOH did not always receive attestation forms prior to members participating in clinical trials, and a limited number of improper Medicaid payments related to investigational services or services not covered by the member’s MCO or lacking prior authorization were identified. DO…
Disclaimer of Opinion due to limitation on the scope of the examination; the scope was not sufficient to express an opinion on CarePlus’ compliance with the specified Medicaid requirements for the period January 1, 2021 through December 31, 2023.
The engagement is framed as a consulting study not an audit, with findings indicating that most reconciliation totals align closely to CDJs while highlighting notable data quality issues that affect GF 360 completion percentages and several delegated vendor categories. While s…
In our opinion, except for the effects of the matters described in the Basis for Qualified Opinion paragraph, New Destiny has complied, in all material respects, with the select requirements of behavioral health services for the period of January 1, 2021 through December 31, 2…
Because the State agency ensured, for the sample items we reviewed, that the MCOs followed all outpatient prescription drug coverage and utilization requirements that were in place during our audit period, including prior authorizations and quantity limits, this report contain…
Because LHCC revised its internal policy during our audit period to ensure that written notices of adverse determinations were sent to enrollees regardless of the enrollees' inpatient status, and because we did not identify any additional concerns after the effective date of t…
In our opinion, the financial statements referred to above present fairly, in all material respects, the respective financial position of the governmental activities, each major fund, and the aggregate remaining fund information of the Department, as of June 30, 2025, and the…
Not sufficient.
DHS has long-standing authority to impose sanctions for kickbacks under federal SSA provisions and state law; however, a decades-old error in DHS's administrative rules defining fraud and ambiguous suspension authority limited action on kickbacks alone. The 2025 legislative ch…