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.
Oversight Of Medicaid Quality Care
The audit found significant governance and data-use gaps in LDH’s oversight of Medicaid MCOs, including incentive design that can pay for non-improving performance, lack of data-driven identification ...
Additional Actions Needed to Enhance Program Integrity and Save Billions
While CMS has made significant progress in reducing improper payments and implementing GAO recommendations, ongoing efforts and additional actions are necessary to further enhance program integrity, p...
Continuing Care Retirement Communities
The audit identifies significant non-compliance with state statutes governing CCP registrations and continuum-of-care verification, resulting in substantial revenue losses to the Quality Care Assessme...
CMS Did Not Ensure That Selected States Complied With Medicaid Managed Care Mental Health and Substance Use Disorder Parity Requirements
CMS did not ensure that selected States complied with Medicaid managed care MH/SUD parity requirements; noncompliance was widespread across eight States, including missing parity provisions in contrac...
Medicaid Capitation Paid for Members Residing in Other States
Rhode Island Medicaid paid approximately $38.4 million in capitation payments to MCOs for members who were not residing in Rhode Island, indicating noncompliance with state and federal residency requi...
The Cost of Concurrent Enrollment
The audit highlights significant financial waste due to unmanaged concurrent Medicaid enrollment across states, emphasizing the need for technological improvements, better inter-state communication, a...
Medicaid Audit Unit—Annual Report
The audit identified an estimated $84,832,094 in capitation payments to MassHealth members residing outside Massachusetts. MassHealth has reported actions or planned actions on all four audit recommen...
Colorado Could Better Ensure That Nursing Homes Comply With Federal Requirements For Life Safety, Emergency Preparedness, And Infection Control
Colorado could better ensure that nursing homes participating in Medicare and Medicaid comply with Federal life safety, emergency preparedness, and infection control requirements. Deficiencies were ob...
Medicaid Program: Claims Processing Activity October 1, 2023 Through March 31, 2024
The audit concluded that eMedNY reasonably ensured that Medicaid claims were submitted by approved providers, processed in accordance with Medicaid requirements, and resulted in correct payments. Howe...
The Comprehensive Perinatal Services Program
The State has provided limited oversight of the Comprehensive Perinatal Services Program and has not meaningfully improved the program. Data limitations and insufficient oversight hinder the ability t...
Maryland Department of Health Medical Care Programs Administration Managed Care Program Audit Report
MDH’s corrective actions addressing the identified audit issues are considered sufficient to address all audit issues.
Lead Testing for Children Enrolled in Medicaid
Washington State has not ensured adequate lead testing for children enrolled in Medicaid, despite the known risks and federal requirements. Testing rates are low and variable, especially among high-ri...
Maryland Department of Health Medical Care Programs Administration Audit Report
MCPA’s accountability and compliance level was unsatisfactory.
Multiple States Made Medicaid Capitation Payments to Managed Care Organizations After Enrollees’ Deaths
The report concludes that improper Medicaid capitation payments to MCOs on behalf of deceased enrollees remain a persistent issue across states, with prior unallowable payments totaling about $249 mil...
Children Enrolled in Medi‑Cal Face Challenges in Accessing Behavioral Health Care
The departments can do more to detect and address access challenges faced by children in Medi-Cal seeking behavioral health services. Current monitoring and survey practices have significant weaknesse...
Maryland Department of Health – Medical Care Programs Administration Audit
The audit concluded that the Maryland Department of Health’s Medical Care Programs Administration (MCPA) had an unsatisfactory level of accountability and compliance under the audit rating system, wit...
Medicaid Managed Care Contract Monitoring Follow-Up and Oversight of Health Plan Complaint and Grievance Handling Operational Audit
The audit identified deficiencies in internal controls related to ECGA reporting, data summaries, and follow-up actions, indicating a need for strengthened oversight and documentation.
States Face Ongoing Challenges in Meeting Third-Party Liability Requirements for Ensuring That Medicaid Functions as the Payer of Last Resort
OIG concludes that States continue to face persistent and wide-ranging challenges in meeting third-party liability requirements for Medicaid, even after the Deficit Reduction Act provisions and CMS gu...
New York Did Not Ensure That A Managed Care Organization Complied With Requirements For Denying Prior Authorization Requests
The audit concluded that the New York State Department of Health’s oversight was ineffective in ensuring that CPHL complied with requirements for denying prior authorization requests, resulting in del...
Medicaid Correspondence Performance Audit
The audit concluded that the Department of Health Care Policy & Financing’s Medicaid correspondence exhibits significant clarity, accuracy, and completeness problems across CBMS and non-CBMS letters, ...
Medicaid Program Integrity Opportunities for CMS to Strengthen Use of State Auditor Findings and Collaboration
While CMS has taken steps to improve collaboration with state auditors and analyze audit findings, there remains significant room for improvement in using these findings to enhance Medicaid program ov...
An Actuarial Analysis Of The Health And Human Services Commission’s Fiscal Year 2024 Medicaid Managed Care Rates Actuarial Soundness
The FY 2024 Texas Medicaid managed care capitation rates are actuarially sound overall, with no material program-wide under- or over-funding detected. Milliman identifies several recommendations to st...
Poor Accountability and Transparency Harm Medicaid Patients and Independent Pharmacies
The audit identifies Oregon’s Medicaid PBM framework as overly complex and insufficiently transparent, with limited direct oversight of PBMs by OHA. The report recommends a shift toward stronger patie...