PA · Medicaid jurisdiction

Pennsylvania Medicaid audit evidence

Review reports connected to Pennsylvania Medicaid oversight, ordered by publication date.

Evidence register

2 reports

Published: Jun 2026
Jurisdiction: Pennsylvania

Publishing agency: Office of Inspector General, U.S. Department of Health and Human Services
Report ID: REPORT 161

Medicaid Managed Care Behavioral Health Service Denials in Philadelphia by Community Behavioral Health

CBH did not comply with Federal and State requirements for denying prior-authorization behavioral health services; none of the 100 sampled denials complied with all applicable requirements, indicating potential systemic issues in denials and potential impact on enrollee rights.

Findings: 5
Recommendations: 6

Open evidence record

Source status: Original source

Published: Aug 21, 2024
Jurisdiction: Pennsylvania

Publishing agency: Pennsylvania Department of the Auditor General
Report ID: REPORT 65

Performance Audit Report: Pharmacy Benefit Manager Services for the Physical HealthChoices Medicaid Program in Pennsylvania

The audit identifies three findings with 17 recommendations. DHS generally disagreed with Finding 1 and agreed with Finding 2; PerformRx generally agrees with Finding 3. The auditors note ongoing concerns about spread pricing, data integrity, and contract monitoring, and reser…

Findings: 3
Recommendations: 13

Open evidence record

Source status: Original source