Public audit ledger
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188 reports
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…
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.
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…
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.
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 governance processes.
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 concurrent Medicaid capitation payments. The audit highlighted that concurrent e…
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 agency should enhance oversight and monitoring of contracted health plans to…
MDHHS did not fully remediate Finding 1; a material condition still exists; Finding 2 was complied.
ReCept Pharmacy #1 properly billed for paid claims and complied with applicable contractual, Texas Administrative Code, and federal requirements for most claims tested; however, ReCept did not consistently comply with requirements for accurate claims submissions and dispensing…
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 needed in reporting shared administrative expenses, particularly those alloc…
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 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 improvements.
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 eligibility review contractor adequately determined Medicaid eligibility for three…
Not effective
Moderately effective.
The Department has processes to identify and recoup improper capitation payments, but controls are not sufficiently robust to ensure all improper payments are identified and recouped. The audit identified over $118.5 million in improper capitation payments not recouped for SFY…
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 improper payments and high-risk claims related to in-home services, NEMT, and priv…
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 last resort and that hospice election data and service coordination were prope…