Purpose

To determine the extent of implementation of the five recommendations made in our audit report, Improper Managed Care Payments for Certain Medicaid Recipients (Report 2010-S-66).

Background

Our initial audit report, which was issued on July 24, 2012, determined that, for the five years ended June 30, 2010, Medicaid made $15.6 million in improper managed care payments on behalf of 14,899 recipients who, by State law, were precluded from enrollment in managed care programs. We recommended that the Department investigate the $15.6 million in improper Medicaid managed care payments and strengthen efforts to oversee and monitor Medicaid managed care enrollments.

Key Finding

• Department officials made progress in addressing the problems we identified in our initial audit report. This included the recovery of $6.4 million in improper Medicaid managed care payments. However, further actions are still needed. Of the initial report’s five recommendations, two were implemented, two were partially implemented, and one was not implemented.

Key Recommendation

• Officials are given 30 days after the issuance of the follow-up report to provide information on any actions that are planned to address the unresolved issues discussed in this report.

Other Related Audit/Report of Interest

Department of Health: Improper Managed Care Payments for Certain Medicaid Recipients (2010-S-66)