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.
Medicaid Residency
Overall, the audit concludes that the Louisiana Department of Health should improve its processes for identifying and removing Medicaid beneficiaries who no longer reside in Louisiana, as substantial ...
Kansas Medicaid and CHIP Eligibility Determinations Audit
The audit found that Kansas generally complies with eligibility determination requirements but identified significant areas for improvement, especially in documentation, timely case closure, and resou...
Office of Medicaid (MassHealth) — Review of Capitation Payments
MassHealth did not ensure that it does not make capitation payments to MCOs on behalf of ineligible members who reside outside Massachusetts; the State Auditor identified approximately $84.8 million i...
Medicaid CMS Oversight and Guidance Could Improve Recovery Audit Contractor Program
CMS's oversight of the Medicaid RAC program has been inconsistent, with missed opportunities to recover overpayments and improve program effectiveness. Implementing recommended policies and conducting...
Medicaid Program: Maximizing Drug Rebates Under the Federal Medicaid Drug Rebate Program
While the Department has made significant process improvements and system enhancements in the rebate collection process, certain weaknesses remain, resulting in $183.7 million in Medicaid drug rebates...
Oregon Medicaid Managed Care Medical Loss Ratio Audit
The audit identified areas for improvement in Oregon's Medicaid managed care MLR reporting and oversight processes. While no immediate remittance was required, implementing the recommendations will en...
The Centers for Medicare & Medicaid Services’ Review Contractors Generally Conducted Medicaid Fee-for-Service Claim Reviews for Selected States Under the Payment Error Rate Measurement Program in Accordance with Federal and State Requirements
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 requiremen...
Proposition 56 Tobacco Tax The Department Of Health Care Services Is Not Adequately Monitoring Provider Payments Funded By Tobacco Taxes
Overall, the audit found significant control weaknesses in how Proposition 56 funds and OTP taxes were administered: DHCS did not adequately monitor supplemental payments or provider suspensions in Me...
MassHealth Telehealth Review
MassHealth did not monitor telehealth practices to ensure compliance with its All Provider Bulletins for telehealth encounters, leading to at least $91,852,881 in potentially improper payments.
An Audit Report on the Health and Human Services Commission's Medicaid Managed Care Rate-Setting Process
Milliman concluded that FY2023 capitation rates were actuarially sound, with no program-wide pattern of under- or over-funding, though improvements were recommended in several rate-setting and governa...
Nearly All States Made Capitation Payments for Beneficiaries Who Were Concurrently Enrolled in a Medicaid Managed Care Program in Two States
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 con...
Arizona Health Care Cost Containment System—Review of Selected Behavioral Health Services
AHCCCS did not ensure all peer specialists met qualification and supervision requirements; some peer specialists were not supervised, potentially jeopardizing the quality of peer support services. The...
An Audit Report on Cook Children’s Health Plan, a Managed Care Organization
Cook Children’s Health Plan accurately reported STAR Kids medical and pharmacy expenses in FY 2020 and complied with eligibility requirements for medical and pharmacy claims. However, improvements are...
Office Of Medicaid (MassHealth)—Massachusetts Delivery System Reform Incentive Payment Program
MassHealth did not ensure that DSRIP funding was allocated to ACOs in accordance with the Massachusetts Delivery System Reform Incentive Payment Protocol (Attachment M).
The Centers for Medicare & Medicaid Services’ Eligibility Review Contractor Adequately Determined Medicaid Eligibility for Selected States Under the Payment Error Rate Measurement Program
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 eligib...
An Audit Report on The Health and Human Services Commission’s Oversight of the Medical Transportation Program
The audit identified strengths in some areas but also significant weaknesses that could affect the program's integrity and compliance. The Commission has committed to implementing recommended improvem...
Medicaid Non-Emergency Medical Transportation Services
Not effective
Medicaid and Children's Health Insurance Program Client Eligibility Determinations
Moderately effective.
Timely Notification of Inpatient Hospital Stays Could Help Reduce Improper Medicaid Payments
OHA lacks timely notification of inpatient hospital stays, which results in some claims being paid for services not provided because the Medicaid client was in the hospital; there is significant impro...
MassHealth Payments for Hospice-Related Services for Dual-Eligible Members
MassHealth did not administer payments to non-hospice providers for hospice-related services in compliance with applicable state and federal regulations, including ensuring that Medicaid is payer of l...
Despite the COVID-19 Public Health Emergency, the Department Can Do More to Address Chronic Medi-Cal Eligibility Problems
Health Care Services halted efforts to resolve hundreds of thousands of known Medi-Cal eligibility discrepancies during the public health emergency, leading to a growing backlog and increased risk of ...
Medicaid Program Integrity Examining the Health Care Authority’s oversight of efforts at state agencies
Medicaid is a significant public assistance program in Washington, requiring robust program integrity efforts to ensure proper use of funds. While HCA has taken steps to improve oversight, there are o...
An Audit Report on Blue Cross Blue Shield of Texas, a Managed Care Organization
The audit found that while the Health Plan accurately reported medical, administrative, and quality improvement expenses, its pharmacy expense reporting was flawed due to unallowable practices by the ...
Medicaid Provider Enrollment Performance Audit
The Medicaid Provider Enrollment process in North Carolina did not adequately ensure that only qualified providers were enrolled to serve Medicaid beneficiaries or to receive payments. The Division fa...