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.
Proposition 56 Tobacco Tax State Agencies’ Weak Administration Reduced Revenue by Millions of Dollars and Led to the Improper Use and Inadequate Disclosure of Funds
The audit concludes that inaccuracies in CDTFA’s tax rate calculation and insufficient safeguards and public disclosure across several agencies impeded program integrity, resulting in potential revenu...
Medicaid Program: Improper Medicaid Payments for Individuals Receiving Hospice Services Covered by Medicare
The Office of the Inspector General notes that it is not expressing an opinion on the State Comptroller’s report or its results; however, the OSC encourages CMS to consider the report and its results ...
Medicaid Managed Care Program
The audit found material weaknesses in MEDES controls that allowed improper and potentially preventable capitation payments to be issued, particularly for bypassed and out-of-state and incarcerated pa...
Analysis of Selected Medicaid Claims Data
Agency controls could be enhanced to better prevent or detect potential improper Medicaid claims payments.
Medicaid Eligibility Determinations: Status on the Use of Federal Tax Information
LDH has not implemented the use of federal tax information for MAGI-based Medicaid eligibility determinations as of August 2019. The agency has ceased automated use in LaMEDS, awaiting IRS approvals a...
Improper Billing of Services Within the Medicaid Behavioral Health Program
All issues identified in this report exist because the MCOs, Magellan, and LDH have not established sufficient edit checks to ensure claims and encounters that do not comply with the fee schedule are ...
An Audit Report on Medicaid Managed Care Contract Processes at the Health and Human Services Commission
The audit found that the Health and Human Services Commission has made significant progress in establishing processes and controls related to Medicaid managed care contract management, in compliance w...
Medicaid Managed Care Contract Processes at the Health and Human Services Commission
The Commission has made significant progress in establishing processes and controls for Medicaid managed care contract management, aligning with Senate Bill 894 requirements. However, further efforts ...
Department of Social Services Prescription Drug Oversight
The audit found that while cost containment measures have contributed to reductions in prescription drug payments after 2015, significant control gaps remain, notably the absence of a comprehensive st...
Medicaid Managed Care Improvements Needed to Better Oversee Payment Risks
The GAO found that Medicaid managed care faces significant payment risks and oversight challenges. CMS's efforts to improve program integrity have been delayed and insufficient, risking continued paym...
Performance Audit of Medicaid Managed Care Organizations for Fiscal Year 2016
HFS failed to maintain complete and accurate data to monitor payments to and from MCOs, leading to potential overpayments, duplicate payments, and lack of oversight on costs and claims processing.
Audit of Medicaid Reimbursements Made to Regency Manor Rehabilitation
The audit identified overpayments totaling $58,540.97 due to billing inaccuracies in room and board, and therapy services. The provider is responsible for repayment, and the Department of Job and Fami...
Review of Medicaid Provider Reimbursements made to Crest Transportation Service
The review identified significant non-compliance with Medicaid reimbursement rules by Crest Transportation Service, resulting in overpayments and raising concerns about potential fraud and abuse. The ...