California Claimed at Least $2 Million in Unallowable Medicaid Reimbursement for a Selected Provider’s Opioid Treatment Program Services

The United States currently faces a nationwide public health emergency due to the opioid crisis. Opioid treatment programs (OTPs) provide medication coupled with counseling services (referred to in this report as “OTP services”) for people diagnosed with an opioid use disorder. This audit is part of OIG’s oversight of the integrity and proper stewardship of Federal funds used to combat the opioid crisis. To perform an initial assessment of the risk of improper Medicaid reimbursement for OTP services, we selected for audit an OTP provider that received the highest Medicaid reimbursement for OTP services in California for calendar year 2018.Our objective was to determine whether California claimed Medicaid reimbursement for the selected provider’s OTP services in accordance with Federal and State requirements.