Medicaid Audit Intelligence

Public audit ledger

Medicaid audit reports

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Evidence register

188 reports

Published
Feb 2026
Jurisdiction
Missouri
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 156

Missouri Medicaid Rebates for Physician-Administered and Pharmacy Drugs

Although the State agency improved its controls over invoicing for rebates for physician-administered drugs, during our audit period the State agency did not comply with Federal Medicaid requirements for invoicing manufacturers for rebates for some physician-administered and p…

Findings
6
Recommendations
6
Open evidence record
Source status
Original source
Published
Feb 2026
Jurisdiction
West Virginia
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 155

West Virginia Medicaid Managed-Care Rebates Associated With Physician-Administered Drugs

The Office of Inspector General found that West Virginia did not invoice manufacturers for some rebates due on physician-administered drugs dispensed to enrollees of Medicaid managed-care organizations during the audit period, totaling $8.2 million ($6.1 million Federal share)…

Findings
3
Recommendations
2
Open evidence record
Source status
Original source
Published
Feb 2026
Jurisdiction
Colorado
Publishing agency
Department of Health and Human Services Office of Inspector General Office of Audit Services
Report ID
REPORT 157

Colorado Made at Least $77.8 Million in Improper Fee-for-Service Medicaid Payments for Applied Behavior Analysis Provided to Children

Colorado’s FFS Medicaid payments for Applied Behavior Analysis provided to children did not fully comply with Federal and State requirements, resulting in improper and potentially improper payments and highlighting a need for stronger governance, oversight, and guidance to pre…

Findings
7
Recommendations
5
Open evidence record
Source status
Original source
Published
Feb 20, 2026
Jurisdiction
Texas
Publishing agency
Texas Health and Human Services Office of Inspector General
Report ID
REPORT 141

Dental Value-Added Services—Molina Healthcare

Molina did not consistently submit dental value-added services encounters with the correct financial arrangement code, which may affect the accuracy of FSR data and the computation of capitation rates and potential experience rebates.

Findings
1
Recommendations
5
Open evidence record
Source status
Original source
Published
Feb 20, 2026
Jurisdiction
Texas
Publishing agency
Texas Health and Human Services Commission Office of Inspector General
Report ID
REPORT 140

Dental Value-Added Services—Wellpoint

Wellpoint did not consistently submit dental value-added services encounters with the correct financial arrangement code.

Findings
1
Recommendations
6
Open evidence record
Source status
Original source
Published
Jan 2026
Jurisdiction
Maine
Publishing agency
United States Department of Health and Human Services Office of Inspector General Office of Audit Services
Report ID
REPORT 154

Maine Made at Least $45.6 Million in Improper Fee-for-Service Medicaid Payments for Rehabilitative and Community Support Services Provided to Children Diagnosed With Autism

For our audit period, the Maine Department of Health and Human Services’s FFS Medicaid payments for rehabilitative and community support services provided to children diagnosed with autism included improper and potentially improper payments. Improper payments totaled at least…

Findings
7
Recommendations
4
Open evidence record
Source status
Original source
Published
Jan 30, 2026
Jurisdiction
Texas
Publishing agency
Texas Health and Human Services Office of Inspector General Audit and Inspections Division
Report ID
REPORT 132

Follow-Up Assessment on a Previously Published Audit Report Managed Care Pharmacy Claims Paid to Encore Pharmacy #1

Based on our assessment, Encore Pharmacy #1 fully resolved all reported audit issues. As a result, OIG Audit did not reissue any recommendations from the previous audit.

Findings
2
Recommendations
0
Open evidence record
Source status
Original source
Published
Jan 30, 2026
Jurisdiction
Texas
Publishing agency
Texas Health and Human Services Office of Inspector General
Report ID
REPORT 131

Special Investigative Unit – Blue Cross and Blue Shield

The Blue Cross and Blue Shield of Texas Special Investigative Unit did not operate an effective SIU program and did not comply with requirements related to preventing, detecting, and investigating fraud, waste, and abuse, and reporting accurate information on SIU activities, r…

Findings
10
Recommendations
8
Open evidence record
Source status
Original source
Published
Jan 20, 2026
Jurisdiction
New York
Publishing agency
Office of the New York State Comptroller, Division of State Government Accountability
Report ID
REPORT 172

Medicaid Program – Oversight of Health Homes

DOH did not adequately oversee Medicaid Health Homes to ensure appropriate care and payments, including delays in redesignation reviews, noncompliance with policies, and lack of baseline measurements, with $19.7 million in payments lacking proper MAPP-based support; the agency…

Findings
4
Recommendations
7
Open evidence record
Source status
Original source
Published
Jan 12, 2026
Jurisdiction
Texas
Publishing agency
Texas Health and Human Services Commission Office of Inspector General
Report ID
REPORT 142

Multiple Identification Numbers in Texas Medicaid and CHIP

AES had processes and controls to prevent and detect the creation of multiple IDs and associated overpayments, but improvements can be made to further limit the creation of multiple IDs for Texas Medicaid and CHIP members.

Findings
1
Recommendations
5
Open evidence record
Source status
Original source
Published
Dec 2025
Jurisdiction
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Report ID
REPORT 119

Illinois Medicaid Managed Care Capitation Payments for Incarcerated Enrollees

The audit determined that Illinois made unallowable managed care capitation payments for incarcerated enrollees during the audit period, totaling at least $9.5 million with $8.3 million Federal share, and identified failures to terminate enrollment as required. Recovered findi…

Findings
3
Recommendations
2
Open evidence record
Source status
Original source
Published
Dec 2025
Jurisdiction
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Report ID
REPORT 118

Medicaid Agencies Made Millions in Unallowable Capitation Payments to Managed Care Organizations on Behalf of Deceased Enrollees

We estimate that Medicaid agencies made $207,501,380 ($138,645,710 Federal share) in unallowable capitation payments to MCOs for deceased enrollees during the audit period (July 1, 2021 – June 30, 2022).

Findings
4
Recommendations
2
Open evidence record
Source status
Original source
Published
Oct 30, 2025
Jurisdiction
Massachusetts
Publishing agency
Massachusetts Office of the State Auditor
Report ID
REPORT 122

Review of Durable Medical Equipment Providers

MassHealth did not fully ensure that DME was not ordered by excluded providers or for deceased members, as evidenced by three identified findings and associated overpayments; ongoing post-payment and data-lag issues necessitate strengthened controls and more comprehensive deat…

Findings
3
Recommendations
6
Open evidence record
Source status
Original source
Published
Oct 22, 2025
Jurisdiction
New York
Publishing agency
Office of the New York State Comptroller, Division of State Government Accountability
Report ID
REPORT 123

Medicaid Program: Oversight of Managed Care Provider Networks

DOH did not maintain sufficient oversight of Medicaid managed care provider networks during 2023, with data reliability and process control issues affecting the accuracy of deficiency reporting and SOAs, incomplete communication with MCOs, and potential cost exposure due to in…

Findings
5
Recommendations
3
Open evidence record
Source status
Original source
Published
Sep 2025
Jurisdiction
New Jersey
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 166

New Jersey Did Not Ensure That Some Medicaid Personal Care Assistant Services Provided Under the Personal Preference Program Met Federal and State Requirements

New Jersey did not ensure that the State agency adequately monitored and ensured compliance by its MCOs and fiscal intermediary with Federal and State requirements for PPP PCA services; as a result, the program was vulnerable to misuse of Federal funds and the health and safet…

Findings
5
Recommendations
2
Open evidence record
Source status
Original source
Published
Sep 2025
Jurisdiction
Mississippi
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 167

Mississippi 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 FYs 2021 through 2023. The audit identified underreporting across multiple categories, with 12 cases reported and returned (totaling $290,584) compared with…

Findings
5
Recommendations
5
Open evidence record
Source status
Original source
Published
Sep 2025
Jurisdiction
Federal
Publishing agency
Office of Inspector General, U.S. Department of Health and Human Services
Report ID
REPORT 168

Most Children Enrolled in Medicaid Did Not Receive Timely Suicide-Related Followup Care

Timely followup care after pediatric suicidal thoughts or behaviors is not consistently achieved across states; about half of cases did not have a followup visit within 7 days and 21 percent had none within 60 days; shortages of behavioral health providers and difficulties con…

Findings
5
Recommendations
2
Open evidence record
Source status
Original source
Published
Sep 25, 2025
Jurisdiction
Utah
Publishing agency
Utah Office of the Legislative Auditor General
Report ID
REPORT 125

A Performance Audit of the Office of Inspector General of Medicaid Services: Policy Options for Improved Governance and Medicaid Oversight

The report concludes that Utah’s OIG has not adequately fulfilled its Medicaid oversight mandate and suffers from governance, reporting, and performance weaknesses, with risk-based planning and proactive oversight largely missing; it recommends policy options including structu…

Findings
9
Recommendations
10
Open evidence record
Source status
Original source
Published
Sep 17, 2025
Jurisdiction
Kentucky
Publishing agency
Kentucky Auditor of Public Accounts
Report ID
REPORT 120

How Kentucky Failed to Prevent Over $800 Million of Medicaid Waste

Concurrent capitation payments across state lines resulted in substantial waste (over $800 million) during 2019–2022 due to gaps in residency determination, PARIS/T-MSIS data usage, and contract obligations with MCOs; remedies include stronger leadership, proactive data sharin…

Findings
9
Recommendations
9
Open evidence record
Source status
Original source
Published
Aug 2025
Jurisdiction
Federal
Publishing agency
Centers for Medicare & Medicaid Services
Report ID
REPORT 121

Washington Medicaid Managed Care Medical Loss Ratio Audit

CMS identified eight findings requiring correction, but none resulted in an MLR recalculation below the 85% remittance threshold; the audit identified operational improvements and oversight enhancements to ensure compliance with federal MLR requirements.

Findings
8
Recommendations
6
Open evidence record
Source status
Original source
Published
Aug 21, 2025
Jurisdiction
Nebraska
Publishing agency
Nebraska Auditor of Public Accounts
Report ID
REPORT 126

Medicaid Payments to MCOs for Deceased Individuals

The DHHS procedures for identifying deaths, updating records, and recouping post-death Medicaid payments were found to be insufficient to prevent improper disbursements to MCOs. While some adjustments and recoupments have begun, there are notable opportunities to strengthen in…

Findings
7
Recommendations
4
Open evidence record
Source status
Original source