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Medicaid Program: Oversight of Managed Care Provider Networks
DOH did not maintain sufficient oversight of Medicaid managed care provider networks during 2023, with data reliability and process control issues affecting the accuracy of deficiency reporting and SO...
How Kentucky Failed to Prevent Over $800 Million of Medicaid Waste
Concurrent capitation payments across state lines resulted in substantial waste (over $800 million) during 2019–2022 due to gaps in residency determination, PARIS/T-MSIS data usage, and contract oblig...
Ohio Medicaid Managed Care Medical Loss Ratio Audit
While no remittances were required based on the findings, the audit identified multiple areas for improvement in Ohio’s oversight and reporting processes to ensure compliance with federal requirements...
Managed Care Incentive Payment Program
LDH’s design and lack of oversight of the MCIP program led to the majority of MCIP funds being paid for activities that do not have a direct, measurable result for how they improve access to healthcar...
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 conc...
109
Total Reports
Last 5 years
27
States Covered
84% coverage
0
Critical Findings
Requiring immediate action
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