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Report File
Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Report Number
A-02-16-01005
Report Description

Historically, only certain groups of individuals who had incomes and assets below certain thresholds were eligible for Medicaid (traditional coverage groups). After the passage of the Patient Protection and Affordable Care Act (ACA), some beneficiaries remained eligible under these traditional coverage groups. We refer to these beneficiaries as "non-newly eligible beneficiaries."

Report Type
Audit
Agency Wide
Yes
Number of Recommendations
3
Additional Details
https://oig.hhs.gov/oas/reports/region2/21601005.asp

Open Recommendations

This report has 2 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
267122 No $0 $0

We recommend that the State agency maintain the necessary documentation to determine whether it enrolled individuals who did not meet Federal and State Medicaid eligibility requirements, which could have resulted in up to $1,297,308,200 in potentially improper Federal Medicaid payments over the 6-month audit period

267121 No $0 $0

We recommend that the State agency take the necessary steps to ensure local district and marketplace staff consider all available, relevant information and data sources, as well as all Federal and State requirements when determining Medicaid eligibility, which could have reduced or eliminated an estimated $520,295,792 in overpayments caused by eligibility errors over the 6-month audit period.

Department of Health & Human Services OIG

United States