Medicaid Audit Intelligence

Public audit ledger

Medicaid audit reports

Search the complete report library and verify each record against its publishing agency and original public source.

Evidence register

188 reports

Published
Jul 2025
Jurisdiction
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Report ID
REPORT 46

Wisconsin’s Fee-for-Service Medicaid Payments for Applied Behavior Analysis

The Wisconsin Department of Health Services’ ForwardHealth program did not provide adequate oversight of FFS Medicaid ABA payments, resulting in improper and potentially improper payments for autism-related ABA services. The program had not conducted a statewide postpayment re…

Findings
12
Recommendations
6
Open evidence record
Source status
Original source
Published
Jul 2025
Jurisdiction
North Carolina
Publishing agency
North Carolina Office of the State Auditor
Report ID
REPORT 66

Performance Audit Report July 2025 Medicaid Provider Enrollment Follow-Up Audit

The Division of Health Benefits did not fully implement prior audit recommendations during 2023, leaving ongoing risks to patient safety and Medicaid integrity from providers with suspended licenses, license limitations, unverified credentials (including DEA), and uncorroborat…

Findings
4
Recommendations
6
Open evidence record
Source status
Original source
Published
Jul 2025
Jurisdiction
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Report ID
REPORT 45

Analysis of Selected Nursing Facilities’ Use of Medicaid Reimbursement for Direct Care Compensation

The data brief concludes that there is no clear, positive correlation between higher direct care compensation and higher nursing hours per resident day (HPRD). Increases in direct care compensation are largely attributed to higher labor costs from contracting for nursing staff…

Findings
9
Recommendations
0
Open evidence record
Source status
Original source
Published
Jul 2025
Jurisdiction
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Report ID
REPORT 50

Pennsylvania Capitation Payments for Enrollees With Multiple Medicaid Identification Numbers

The OIG concluded that Pennsylvania made unallowable capitation payments totaling at least $8,784,549 ($4,596,390 Federal share) for enrollees with multiple Medicaid ID numbers during the audit period (January 1, 2019 – December 31, 2022). The unallowable payments were caused…

Findings
3
Recommendations
5
Open evidence record
Source status
Original source
Published
Jul 25, 2025
Jurisdiction
Federal
Publishing agency
Centers for Medicare & Medicaid Services
Report ID
REPORT 11

Ohio Medicaid Managed Care Medical Loss Ratio Audit

While no remittances were required based on the findings, the audit identified multiple areas for improvement in Ohio’s oversight and reporting processes to ensure compliance with federal requirements and enhance program integrity.

Findings
3
Recommendations
11
Open evidence record
Source status
Original source
Published
Jul 16, 2025
Jurisdiction
Illinois
Publishing agency
Illinois Office of the Auditor General
Report ID
REPORT 35

Performance Audit of Medicaid Eligibility Determinations for Long-Term Care

The audit identified significant delays, data inaccuracies, and reporting deficiencies in Illinois' Medicaid long-term care eligibility process. While some system enhancements have been implemented, issues remain with timeliness, data integrity, and reporting practices. The ag…

Findings
7
Recommendations
6
Open evidence record
Source status
Original source
Published
Jun 26, 2025
Jurisdiction
Federal
Publishing agency
U.S. Government Accountability Office
Report ID
REPORT 12

Medicaid Managed Care Improper Payment Estimate

The GAO report highlights that while CMS's current improper payment estimates for Medicaid managed care are near zero, they do not capture all program integrity risks. CMS has taken steps to improve oversight through audits and reviews, but additional measures and data improve…

Findings
5
Recommendations
4
Open evidence record
Source status
Original source
Published
Jun 18, 2025
Jurisdiction
New York
Publishing agency
Office of the New York State Comptroller, Division of State Government Accountability
Report ID
REPORT 54

Medicaid Program: Claims Processing Activity April 1, 2024 Through September 30, 2024

The audit concluded that eMedNY reasonably ensured Medicaid claims were submitted by approved providers, processed in accordance with Medicaid requirements, and paid correctly overall. However, improvements were needed in the processing of certain claim types, with over $11.5…

Findings
6
Recommendations
7
Open evidence record
Source status
Original source
Published
May 2025
Jurisdiction
Federal
Publishing agency
U.S. Department of Health and Human Services, Office of Inspector General
Report ID
REPORT 57

Maryland Did Not Comply With Federal Waiver and State Requirements at 20 Adult Day Care Facilities Audited

The Maryland Department of Health did not fully comply with Federal waiver and State requirements in overseeing adult day care facilities; 253 noncompliance instances were identified across health and safety and administrative areas, with inspections insufficient to detect vio…

Findings
1
Recommendations
3
Open evidence record
Source status
Original source
Published
May 30, 2025
Jurisdiction
Federal
Publishing agency
Centers for Medicare & Medicaid Services
Report ID
REPORT 13

Oklahoma Focused Program Integrity Review Final Report

CMS supports Oklahoma’s efforts and encourages further improvements in program integrity. The review identified four observations for the state’s attention but no non-compliance findings that pose a risk.

Findings
1
Recommendations
5
Open evidence record
Source status
Original source
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