Oregon Medicaid Audit Finds Up to $4.1 Million in Overpayments, Putting Federal Funding at Risk
Secretary of State (SoS) auditors have identified 645 potential duplicate system IDs linked to up to an estimated $4.1 million in Medicaid over-payments, putting Oregon at risk of losing federal funding.
The auditors’ report relates to 2020 to 2024, when the Oregon Health Authority (OHA) paid $37 billion to Coordinated Care Organizations (CCOs).
Auditors concluded that additional worker training is needed, especially as recent changes to Medicaid policy require eligibility to be redetermined every six months.
Federal Funding Risk and Required Fixes
One in three Oregonians relies on Medicaid for healthcare needs, a program heavily funded by the federal government.
Last year, Oregon spent $19 billion on Medicaid, $13 billion of which was federal funding. The federal government can reduce or withhold funding from states that are out of compliance with rules.
For this reason, OHA must run Medicaid efficiently and effectively to remain in compliance with federal rules.
The audit report relates to data matches between Medicaid recipients from 2020 to 2024 to identify potential duplicate recipients. They identified 645 potential duplicates of more than 2 million IDs checked.
Testing found that the OHA made between $232,000 and $4.1 million in duplicate capitation payments for the Medicaid program between 2020 and 2024.
The auditors recommend five strategies to comply with federal regulations, to which the OHA has agreed. These are:
1 – Review the IDs that were not detail tested to determine if they are duplicates and if over-payments occurred. Return the federal portion of the over-payments to the government.
2 – Recoup duplicate payments from CCOs.
- Provide specific training to eligibility workers on best practices for researching applicants and potential matches.
- Develop future system enhancements to reduce the manual research that is currently performed.
- Design and implement a quality control process to prevent and detect duplicate IDs.
The auditors will review the OHA’s progress on implementing the recommendations within the next 18 months.