Medicaid Audit Intelligence

Public audit ledger

Medicaid audit reports

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Evidence register

188 reports

Published
Jul 8, 2021
Jurisdiction
Washington
Publishing agency
Office of the Washington State Auditor
Report ID
REPORT 33

Medicaid Program Integrity Examining the Health Care Authority’s oversight of efforts at state agencies

Medicaid is a significant public assistance program in Washington, requiring robust program integrity efforts to ensure proper use of funds. While HCA has taken steps to improve oversight, there are opportunities to strengthen strategic planning, performance measurement, and o…

Findings
4
Recommendations
3
Open evidence record
Source status
Original source
Published
Jul 8, 2021
Jurisdiction
California
Publishing agency
California State Auditor
Report ID
REPORT 116

Despite the COVID-19 Public Health Emergency, the Department Can Do More to Address Chronic Medi-Cal Eligibility Problems

Health Care Services halted efforts to resolve hundreds of thousands of known Medi-Cal eligibility discrepancies during the public health emergency, leading to a growing backlog and increased risk of improper payments and federal penalties; some emergency waivers and communica…

Findings
6
Recommendations
6
Open evidence record
Source status
Original source
Published
Jun 25, 2021
Jurisdiction
Texas
Publishing agency
Texas State Auditor's Office
Report ID
REPORT 7

An Audit Report on Blue Cross Blue Shield of Texas, a Managed Care Organization

The audit found that while the Health Plan accurately reported medical, administrative, and quality improvement expenses, its pharmacy expense reporting was flawed due to unallowable practices by the Pharmacy Benefit Manager, which could impact Medicaid costs and program integ…

Findings
5
Recommendations
3
Open evidence record
Source status
Original source
Published
Feb 2021
Jurisdiction
North Carolina
Publishing agency
North Carolina Office of the State Auditor
Report ID
REPORT 67

Medicaid Provider Enrollment Performance Audit

The Medicaid Provider Enrollment process in North Carolina did not adequately ensure that only qualified providers were enrolled to serve Medicaid beneficiaries or to receive payments. The Division failed to monitor license suspensions/terminations, allowed providers with lice…

Findings
4
Recommendations
14
Open evidence record
Source status
Original source
Published
Jan 5, 2021
Jurisdiction
California
Publishing agency
California State Auditor
Report ID
REPORT 113

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 revenue losses and misallocation of Prop 56 funds intended for health and public he…

Findings
5
Recommendations
8
Open evidence record
Source status
Original source
Published
Dec 28, 2020
Jurisdiction
New York
Publishing agency
Office of the New York State Comptroller, Division of State Government Accountability
Report ID
REPORT 89

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 and work with state partners to ensure the federal share of improper Medicaid…

Findings
10
Recommendations
9
Open evidence record
Source status
Original source
Published
Nov 2020
Jurisdiction
Missouri
Publishing agency
Missouri State Auditor
Report ID
REPORT 79

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 participants. While MEDES updates have improved functionality for new participa…

Findings
4
Recommendations
4
Open evidence record
Source status
Original source
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