Medicaid audit reports
Browse every indexed Medicaid audit report. Each listing links to a crawlable detail page with conclusions, findings, recommendations, and the original public source document.
Managed Care Incentive Payment Program
LDH’s design and lack of oversight of the MCIP program led to the majority of MCIP funds being paid for activities that do not have a direct, measurable result for how they improve access to healthcar...
Colorado Made Capitation Payments to Managed Care Organizations After Enrollees’ Deaths
The audit found that Colorado made unallowable capitation payments to Medicaid managed care organizations for deceased enrollees, resulting in significant financial losses and reporting inaccuracies. ...
Performance Audit of the Health Benefits for Immigrant Seniors and Adults
The audit revealed significant discrepancies between estimated and actual enrollment and costs, issues with data accuracy and eligibility verification, and the need for improved controls to prevent in...
Twelve Selected States Did Not Accurately Calculate the Federal Share of Medicaid Collections Subject to the Increased COVID-19 Federal Medical Assistance Percentages
Twelve of the thirteen selected States did not accurately calculate the Federal share of Medicaid collections subject to the increased COVID-19 FMAP, resulting in net underreporting of $61.8 million. ...
Office of Medicaid—Review of Capitation Payments With Multiple Identification Numbers
MassHealth did not ensure that capitation payments were not made on behalf of Medicaid beneficiaries who were assigned multiple IDs.
Department of Medical Assistance Services Report on Audit for the Year Ended June 30, 2024
Medical Assistance Services properly stated, in all material respects, the amounts recorded and reported in the Commonwealth’s accounting and financial reporting system, Medical Assistance Services’ f...
Medicaid Program: Overpayments for Medicare Part C Claims
DOH oversight identified improper Medicaid payments related to Medicare Part C cost-sharing, primarily driven by provider misinterpretation of rules, incomplete CARC reporting, and system limitations....
Medicaid Program: Provider Compliance With the Electronic Visit Verification Program
DOH’s EVV program showed significant control weaknesses and data quality issues, with large volumes of Medicaid payments made without matching EVV records and with low EVV-claim match rates (56% for P...
Follow-Up Report on Prior Audit Recommendations Medicaid Home Help Program Michigan Department of Health and Human Services
Partially complied. A reportable condition exists.
Electronic Visit Verification Audit Ohio Department of Medicaid
The audit identified significant gaps in EVV utilization and matching, with only 44% of claims supported by EVV data in 2022. The Department has made efforts to implement EVV but faces challenges incl...
Estate Recovery Audit Report
The division had adequate controls to ensure compliance with federal and state regulations and general information system controls were in place and functioning. However, outdated policies and procedu...
The Oregon Eligibility System Appropriately Determines Eligibility, But Input Errors Continue to Occur
The audit found that the ONE system largely determines eligibility accurately for Medical and SNAP programs, and automated eligibility determinations are generally effective. However, input errors, ma...
Examining Washington’s Concurrent Medicaid Enrollments
The audit highlights significant financial waste due to concurrent Medicaid enrollments, emphasizing the need for improved communication, data sharing, and federal solutions to prevent unnecessary pre...
Without Federal Action, States Will Continue to Pay Millions of Dollars in Duplicate Medicaid Payments
The audit concludes that without federal action, states will continue to pay millions of dollars in duplicate Medicaid payments; stronger data sharing and real-time enrollment data are needed; Do Not ...
Performance Audit of Selected Programs and Activities of the Division of TennCare
The Division of TennCare has made progress in implementing TennCare III initiatives, unwinding renewals, and maintaining cybersecurity controls, but faces ongoing risks in behavioral health provider n...
Hospice Care Claims and Fiscal Agent Contract
The Division lacks adequate controls to ensure hospice care provider payments comply with federal and state Medicaid policies.
Performance Audit Report: Pharmacy Benefit Manager Services for the Physical HealthChoices Medicaid Program in Pennsylvania
The audit identifies three findings with 17 recommendations. DHS generally disagreed with Finding 1 and agreed with Finding 2; PerformRx generally agrees with Finding 3. The auditors note ongoing conc...
Maryland Department Of Health Pharmacy Services Audit Report
MDH’s pharmacy services program exhibits governance and control weaknesses across manual claims processing, provider licensure verification, program audits, and MADAP rebates, leading to substantial o...
California Payments for Enrollees With Concurrent Medicaid Enrollment in Another State
We estimated that the State agency incurred costs of approximately $19.9 million ($15.5 million Federal share) for August 2021 capitation payments made on behalf of enrollees who were residing and con...
Medicaid Dental Benefit Program Manager - DentaQuest Informational Brief
The informational brief presents a comprehensive analysis of DentaQuest’s performance as the Medicaid dental benefit program manager, highlighting ongoing concerns with network adequacy, claims proces...
North Carolina Did Not Report and Return All Medicaid Overpayments for the State's Medicaid Fraud Control Unit Cases
The State agency did not report and return the Federal share of all MFCU-determined Medicaid overpayments identified for the period under review (October 1, 2019 through September 30, 2021).
California Improperly Claimed $52.7 Million in Federal Medicaid Reimbursement for Capitation Payments Made on Behalf of Noncitizens With Unsatisfactory Immigration Status
California improperly claimed Federal Medicaid reimbursement for capitation payments to noncitizens with UIS by applying an outdated proxy percentage that did not reflect the true costs of nonemergenc...
Colorado's Program Integrity Section Reporting of Medicaid Overpayments
Colorado did not report and refund the correct Federal share of Medicaid overpayments identified by its Program Integrity Section during Oct 1, 2014 through Dec 31, 2020; 80 of 403 cases contained unr...
Evaluation Of The Colorado Recovery Audit Contractor Program
HCPF’s Medicaid Recovery Audit Contractor program generally adheres to federal and state requirements but requires stronger contract oversight and program management to ensure efficient operation, red...