Public audit ledger
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154 reports
The State has provided limited oversight of the Comprehensive Perinatal Services Program and has not meaningfully improved the program. Data limitations and insufficient oversight hinder the ability to determine whether Medi-Cal members receive CPSP services as intended or whe…
MDH’s corrective actions addressing the identified audit issues are considered sufficient to address all audit issues.
Washington State has not ensured adequate lead testing for children enrolled in Medicaid, despite the known risks and federal requirements. Testing rates are low and variable, especially among high-risk populations, indicating a need for improved monitoring, guidance, and outr…
The report concludes that improper Medicaid capitation payments to MCOs on behalf of deceased enrollees remain a persistent issue across states, with prior unallowable payments totaling about $249 million and ongoing uncollected federal shares. While CMS has made substantial p…
MCPA’s accountability and compliance level was unsatisfactory.
The departments can do more to detect and address access challenges faced by children in Medi-Cal seeking behavioral health services. Current monitoring and survey practices have significant weaknesses, and regional disparities and provider shortages exacerbate access issues.…
The audit concluded that the Maryland Department of Health’s Medical Care Programs Administration (MCPA) had an unsatisfactory level of accountability and compliance under the audit rating system, with multiple significant findings related to third-party liability interfaces,…
The audit identified deficiencies in internal controls related to ECGA reporting, data summaries, and follow-up actions, indicating a need for strengthened oversight and documentation.
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.
The audit concluded that the Department of Health Care Policy & Financing’s Medicaid correspondence exhibits significant clarity, accuracy, and completeness problems across CBMS and non-CBMS letters, including duplicated and contradictory messages, missing information, noncomp…
While CMS has taken steps to improve collaboration with state auditors and analyze audit findings, there remains significant room for improvement in using these findings to enhance Medicaid program oversight and prevent improper payments.
The FY 2024 Texas Medicaid managed care capitation rates are actuarially sound overall, with no material program-wide under- or over-funding detected. Milliman identifies several recommendations to strengthen the rate-setting process and reduce future risk, and notes that CMS…
The audit identifies Oregon’s Medicaid PBM framework as overly complex and insufficiently transparent, with limited direct oversight of PBMs by OHA. The report recommends a shift toward stronger patient and pharmacy protections, uniform formularies, fiduciary duties for PBMs,…
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 PMPM payments were made to out-of-state-residing beneficiaries and related ou…
The audit found that Kansas generally complies with eligibility determination requirements but identified significant areas for improvement, especially in documentation, timely case closure, and resource verification. The improper payments highlight the need for enhanced overs…
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 in overpayments and issued recommendations to strengthen residency verificatio…
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 targeted studies could enhance the program's efficiency and recovery potential.
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 not invoiced during the audit period.
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 enhance compliance, accuracy, and program integrity.
Based on the sampling results, 59% of PARIS alerts were not worked or not worked timely; this undermines the effectiveness of PARIS in controlling improper capitation payments. The Department’s corrective actions and monitoring efforts are ongoing, and the audit results suppor…
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.
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 Medi-Cal, CDTFA did not consistently verify wholesale costs for OTP tax calcula…
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.