Public audit ledger
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188 reports
The audit found significant governance and data-use gaps in LDH’s oversight of Medicaid MCOs, including incentive design that can pay for non-improving performance, lack of data-driven identification of non-utilizing beneficiaries and preventive service gaps, fragmented compla…
While CMS has made significant progress in reducing improper payments and implementing GAO recommendations, ongoing efforts and additional actions are necessary to further enhance program integrity, prevent fraud, and realize substantial cost savings.
The audit identifies significant non-compliance with state statutes governing CCP registrations and continuum-of-care verification, resulting in substantial revenue losses to the Quality Care Assessment fund and increased reliance on State General Funds. It recommends substant…
CMS did not ensure that selected States complied with Medicaid managed care MH/SUD parity requirements; noncompliance was widespread across eight States, including missing parity provisions in contracts, lack of parity analyses and public posting, and restrictive practices by…
Rhode Island Medicaid paid approximately $38.4 million in capitation payments to MCOs for members who were not residing in Rhode Island, indicating noncompliance with state and federal residency requirements; controls over residency verification were not fully effective, but P…
The audit highlights significant financial waste due to unmanaged concurrent Medicaid enrollment across states, emphasizing the need for technological improvements, better inter-state communication, and proactive identification processes to safeguard public funds.
The audit identified an estimated $84,832,094 in capitation payments to MassHealth members residing outside Massachusetts. MassHealth has reported actions or planned actions on all four audit recommendations (three fully implemented and one in progress). Follow-up post-audit s…
The audit concluded that eMedNY reasonably ensured that Medicaid claims were submitted by approved providers, processed in accordance with Medicaid requirements, and resulted in correct payments. However, the audit identified a number of improper payments across several catego…
Colorado could better ensure that nursing homes participating in Medicare and Medicaid comply with Federal life safety, emergency preparedness, and infection control requirements. Deficiencies were observed across all 20 nursing homes audited, indicating ongoing oversight chal…
The audit found that the Department’s oversight of Medicaid drug payments and the capitation rate adjustment process were inadequate, resulting in a substantial amount of improper MCO payments for drugs from manufacturers without an NDRA; the Department should revise the rate…
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…
MCPA’s accountability and compliance level was unsatisfactory.
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…
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,…
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 identified deficiencies in internal controls related to ECGA reporting, data summaries, and follow-up actions, indicating a need for strengthened oversight and documentation.
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,…