Colorado Made Capitation Payments to Managed Care Organizations After Enrollees' Deaths

Date Issued

Friday, February 14, 2025

Submitting OIG

Department of Health & Human Services OIG

Agencies Reviewed/Investigated

Department of Health & Human Services

Report Number

A-07-21-05132

Report Type

Audit

Agency Wide

Yes

Number of Recommendations

Questioned Costs

Funds for Better Use

Report updated under NDAA 5274

External Link

Open Recommendations

This report has 2 open recommendations.

Recommendation Number	Significant Recommendation	Recommended Questioned Costs	Recommended Funds for Better Use
25-A-07-044.01	No	$6,012,198	$0
We recommend that the Colorado Department of Health Care Policy and Financing refund $6,012,198 to the Federal Government, consisting of $3,509,358 (Federal share) of capitation payments made on behalf of deceased enrollees who had a date of death recorded in SSA's DMF but not in the State agency's eligibility system; $293,890 (Federal share) of capitation payments made on behalf of deceased enrollees who had a date of death recorded in SSA's DMF and in the State agency's eligibility system; and $2,208,950 (Federal share) in other Medicaid expenditures that the State agency had previously overreported.
25-A-07-044.01	No	$6,012,198	$0
We recommend that the Colorado Department of Health Care Policy and Financing refund $6,012,198 to the Federal Government, consisting of $3,509,358 (Federal share) of capitation payments made on behalf of deceased enrollees who had a date of death recorded in SSA's DMF but not in the State agency's eligibility system; $293,890 (Federal share) of capitation payments made on behalf of deceased enrollees who had a date of death recorded in SSA's DMF and in the State agency's eligibility system; and $2,208,950 (Federal share) in other Medicaid expenditures that the State agency had previously overreported.