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 guidance. The report notes substantial reporting errors by numerous States, lim…
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 delays and potential adverse impacts on Medicaid enrollees' health and safety.
CMS’s review contractors adequately conducted Medicaid FFS claim reviews for three States (Arkansas, Connecticut, and New Mexico) under the PERM program in accordance with Federal and State requirements.
CMS did not concur with the recommendations. The OIG maintains that the recommendations are valid and will continue to work with States to identify opportunities to reduce the number and amount of concurrent Medicaid capitation payments. The audit highlighted that concurrent e…
We determined that CMS’s eligibility review contractor correctly determined Medicaid eligibility for the beneficiaries associated with all 100 sampled claims. Based on our sample results, CMS’s eligibility review contractor adequately determined Medicaid eligibility for three…