Medicaid Audit Intelligence

Public audit ledger

Medicaid audit reports

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Evidence register

154 reports

Published
Apr 2025
Jurisdiction
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Report ID
REPORT 51

Audit Of Ohio Adult Day Health Care Services

The Ohio Department of Medicaid did not fully comply with Federal waiver and State requirements in overseeing providers serving adults in the ADS program; inspections were insufficient to ensure a continuously safe and nonhazardous environment, placing adults at risk.

Findings
1
Recommendations
1
Open evidence record
Source status
Original source
Published
Apr 14, 2025
Jurisdiction
Kansas
Publishing agency
Kansas Office of the Medicaid Inspector General
Report ID
REPORT 82

School-Based Fee-for-Service Medicaid Reimbursements

The audit identifies widespread weaknesses in Kansas’s school-based Medicaid FFS program, including policy misalignments with federal guidance, documentation gaps, and data integrity issues that contributed to unreconciled payments and potential multi-million-dollar improper p…

Findings
12
Recommendations
10
Open evidence record
Source status
Original source
Published
Mar 2025
Jurisdiction
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Report ID
REPORT 49

Texas Did Not Fully Comply With Federal Waiver And State Health, Safety, And Administrative Requirements At All 20 Adult Day Activity And Health Service Facilities Audited

The State agency did not fully comply with Federal waiver and State requirements in overseeing DAHS facilities serving people with special health care needs, and its inspections were not sufficient to ensure a safe and nonhazardous environment, leaving program participants at…

Findings
8
Recommendations
3
Open evidence record
Source status
Original source
Published
Mar 2025
Jurisdiction
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Report ID
REPORT 56

North Carolina’s Medicaid Control Environment, Risk Management Practices, and Governing Processes Were Assessed as Moderate Risk

Overall, the audit determined that North Carolina's Medicaid control environment, risk management practices, and governing processes operate at a moderate risk level, with three risk areas rated high and three rated moderate; the State agency has implemented numerous controls…

Findings
7
Recommendations
11
Open evidence record
Source status
Original source
Published
Mar 12, 2025
Jurisdiction
Louisiana
Publishing agency
Louisiana Legislative Auditor
Report ID
REPORT 105

Maternal Health Outcomes

Overall, we found an increase in the number of pregnant women in Louisiana who did not receive prenatal care as recommended, with pregnant Medicaid beneficiaries representing a disproportionate share of women without prenatal care.

Findings
10
Recommendations
7
Open evidence record
Source status
Original source
Published
Mar 5, 2025
Jurisdiction
Louisiana
Publishing agency
Louisiana Legislative Auditor
Report ID
REPORT 104

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 healthcare, improve quality of care, or enhance the health of Medicaid beneficiaries.

Findings
7
Recommendations
5
Open evidence record
Source status
Original source
Published
Feb 2025
Jurisdiction
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Report ID
REPORT 37

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. The State agency lacked adequate controls and policies to prevent and recover…

Findings
0
Recommendations
0
Open evidence record
Source status
Original source
Published
Feb 28, 2025
Jurisdiction
Texas
Publishing agency
Texas Health and Human Services Commission Office of Inspector General
Report ID
REPORT 143

Special Investigative Unit Wellpoint Texas

The Wellpoint Texas SIU did not consistently comply with state and contractual requirements related to preventing, detecting, and investigating fraud, waste, and abuse and reporting reliable information on SIU activities, results, and recoveries to the Texas Health and Human S…

Findings
8
Recommendations
5
Open evidence record
Source status
Original source
Published
Feb 26, 2025
Jurisdiction
Illinois
Publishing agency
Illinois Office of the Auditor General
Report ID
REPORT 21

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 ineligible or duplicate enrollments. These findings highlight the importance of…

Findings
6
Recommendations
2
Open evidence record
Source status
Original source
Published
Feb 11, 2025
Jurisdiction
Texas
Publishing agency
Texas Health and Human Services Office of Inspector General Audit and Inspections Division
Report ID
REPORT 144

Follow-Up Assessment on a Previously Published Audit Report Managed Care Claims Submitted by Cook Children’s Home Health

Based on our assessment, Cook Children’s Home Health did not fully resolve some reported audit issues and the agency must repay $1,064.92 to the state of Texas for overpayments identified during this assessment; two recommendations from the previous audit were reissued and mod…

Findings
5
Recommendations
2
Open evidence record
Source status
Original source
Published
Jan 23, 2025
Jurisdiction
Texas
Publishing agency
Texas Health and Human Services Commission Office of Inspector General
Report ID
REPORT 145

UnitedHealthcare Dental’s Financial Statistical Reports

UnitedHealthcare Dental had a process for preparing and reviewing FSRs; however, internal controls were not always effective and allowed for reporting errors, which resulted in overstating reported expenses by $799,351.

Findings
3
Recommendations
4
Open evidence record
Source status
Original source
Published
Dec 2024
Jurisdiction
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Report ID
REPORT 44

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. CMS concurred with all four recommendations and described actions to address…

Findings
5
Recommendations
4
Open evidence record
Source status
Original source
Published
Dec 13, 2024
Jurisdiction
Virginia
Publishing agency
Virginia Auditor of Public Accounts
Report ID
REPORT 86

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’ financial systems, and supplemental information and attachments submitted to t…

Findings
7
Recommendations
7
Open evidence record
Source status
Original source
Published
Dec 4, 2024
Jurisdiction
New York
Publishing agency
Office of the New York State Comptroller, Division of State Government Accountability
Report ID
REPORT 52

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. The audit results indicate substantial recoveries and opportunities to stren…

Findings
5
Recommendations
8
Open evidence record
Source status
Original source
Published
Nov 13, 2024
Jurisdiction
New York
Publishing agency
Office of the New York State Comptroller, Division of State Government Accountability
Report ID
REPORT 103

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 PC and 11% for HHC). The VO pre-claim review requirement ended in January 2024…

Findings
6
Recommendations
11
Open evidence record
Source status
Original source
Published
Nov 1, 2024
Jurisdiction
Ohio
Publishing agency
Ohio Auditor of State
Report ID
REPORT 22

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 including low provider compliance, technical issues, and stakeholder engagement.…

Findings
5
Recommendations
3
Open evidence record
Source status
Original source
Published
Nov 1, 2024
Jurisdiction
New Jersey
Publishing agency
New Jersey Office of the State Auditor
Report ID
REPORT 85

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 procedures related to estate recovery led to inconsistent case processing and inadeq…

Findings
1
Recommendations
3
Open evidence record
Source status
Original source
Published
Oct 2024
Jurisdiction
Oregon
Publishing agency
Oregon Secretary of State, Audits Division
Report ID
REPORT 87

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, manual data entry, and inconsistent override monitoring create risk for incorre…

Findings
6
Recommendations
3
Open evidence record
Source status
Original source
Published
Oct 31, 2024
Jurisdiction
Texas
Publishing agency
Texas Health and Human Services Commission Office of Inspector General
Report ID
REPORT 148

Managed Care Pharmacy Benefit Services – Aetna

CaremarkPCS Health, LLC (Caremark) and Aetna Better Health of Texas Inc. (Aetna) employed unallowable pricing models to reduce prescription expenses, and Aetna incorrectly reported expenses on its financial statistical reports to HHSC.

Findings
3
Recommendations
4
Open evidence record
Source status
Original source
Published
Oct 31, 2024
Jurisdiction
Texas
Publishing agency
Texas Health and Human Services Office of Inspector General
Report ID
REPORT 147

Managed Care Pharmacy Benefit Services – Wellpoint

The Texas OIG found that the involved entities employed unallowable pricing practices to reduce prescription expenses, and Wellpoint incorrectly reported expenses on FSRs, with scope limitations due to Caremark's restricted access. The report concludes that these practices, in…

Findings
6
Recommendations
5
Open evidence record
Source status
Original source
Published
Oct 28, 2024
Jurisdiction
Washington
Publishing agency
Office of the Washington State Auditor
Report ID
REPORT 32

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 premium payments and optimize Medicaid spending.

Findings
5
Recommendations
5
Open evidence record
Source status
Original source