Medicaid Audit Intelligence

Public audit ledger

Medicaid audit reports

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Evidence register

154 reports

Published
Sep 11, 2019
Jurisdiction
Louisiana
Publishing agency
Louisiana Legislative Auditor
Report ID
REPORT 61

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 and addressing security and space requirements. The IRS-compliant environment…

Findings
9
Recommendations
2
Open evidence record
Source status
Original source
Published
Sep 4, 2019
Jurisdiction
Louisiana
Publishing agency
Louisiana Legislative Auditor
Report ID
REPORT 62

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 denied. LDH states that post-pay reviews and other analytics are in place, bu…

Findings
6
Recommendations
2
Open evidence record
Source status
Original source
Published
Jan 2019
Jurisdiction
Texas
Publishing agency
Texas State Auditor's Office
Report ID
REPORT 6

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 with Senate Bill 894. However, some planned improvements are still in progress…

Findings
5
Recommendations
5
Open evidence record
Source status
Original source
Published
Jan 19, 2019
Jurisdiction
Texas
Publishing agency
Texas State Auditor's Office
Report ID
REPORT 26

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 are needed to fully implement planned audits, monitoring activities, and IT c…

Findings
4
Recommendations
6
Open evidence record
Source status
Original source
Published
Dec 2018
Jurisdiction
Missouri
Publishing agency
Missouri State Auditor
Report ID
REPORT 80

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 statewide PDMP and incomplete collection of National Drug Codes for physician-a…

Findings
4
Recommendations
0
Open evidence record
Source status
Original source
Published
Jul 26, 2018
Jurisdiction
Federal
Publishing agency
U.S. Government Accountability Office
Report ID
REPORT 28

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 payment errors and fraud. Strengthening oversight and guidance is essential to mi…

Findings
3
Recommendations
3
Open evidence record
Source status
Original source
Published
Jun 29, 2000
Jurisdiction
Ohio
Publishing agency
Ohio Auditor of State
Report ID
REPORT 19

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 provider’s documentation deficiencies, billing irregularities, and the owner’…

Findings
8
Recommendations
4
Open evidence record
Source status
Original source