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Where To Report Waste
Fraud, Abuse, Or Retaliation
Where To Report Waste Fraud, Abuse, Or Retaliation

Ohio Made Medicaid Capitation Payments That Were Duplicative or Were Improper Based on Beneficiary Eligibility Status or Demographics

Submitting OIG: 
Department of Health & Human Services OIG
Report Description: 
Ohio makes capitation payments to five managed care organizations (MCOs) for beneficiaries in the Medicaid Managed Care (MMC) program. Previous OIG reviews in other States identified Medicaid payments made on behalf of ineligible beneficiaries and duplicative monthly capitation payments.
Date Issued: 
Thursday, September 12, 2019
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-05-16-00061
Component, if applicable: 
Centers for Medicare & Medicaid Services
Location(s): 
OH
United States
Type of Report: 
Audit
View Document: 
AttachmentSize
PDF icon 51600061.pdf664.52 KB
Additional Details Link: 
https://oig.hhs.gov/oas/reports/region5/51600061.asp

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
267402 Open No
We recommend that the Ohio Department of Medicaid refund $6,729,855 (Federal share) in overpayments to the Federal Government
267405 Open No
We recommend that the Ohio Department of Medicaid implement system prompts in Ohio Benefits that encourage users to verify the beneficiary’s date of birth or gender before making changes in the system
Displaying 2 of 2 Recommendations