Failure to appropriately determine Medicaid eligibility for 115,200 recipients cost the Oregon Health Authority approximately $88 million in "avoidable expenditures," according to an audit released Wednesday by the Secretary of State's office.
The audit concluded the OHA should improve its methods to prevent improper Medicaid payments and strengthen procedures to recover misspent money.
"The amount of wasteful and incompetent spending at OHA has been staggering and has gone on for at least the past four years," Secretary of State Dennis Richardson said in a statement accompanying the audit.
Among the audit's recommendations are that OHA should: increase oversight of Coordinated Care Organization programs' integrity efforts; clarify rules regarding the accountability of Medicaid providers for improper payments; explore incentive programs to better prevent, detect or recover overpayments; and annually reconcile all individuals in various computer systems to verify that their eligibility is appropriately re-determined.
While OHA agreed with the audit's eight final recommendations, the agency pushed back against some underlying assumptions and estimates that were used to arrive at those conclusions.
The agency disagreed that there were 31,300 "questionable" payments in 15 months, as stated in the audit, because an analysis of 2,700 of those transactions showed that 98 percent of payments were appropriate. They also disputed the characterization that the $88 million in payments to cover 115,200 people was "avoidable" because federal officials approved delaying eligibility renewals after the complete failure of the Cover Oregon insurance program.
Of those people, OHA previously reported that 24,100 no longer qualified for the program and 23,500 failed to respond and were removed from the Medicaid caseload, though they could be retroactively added back.
Despite those disagreements, OHA officials said they already have begun to implement some of the audit's recommendations.
"We look forward to reporting on our progress to implement the recommendations of the audit and continue to improve our business practices," said Laura Robison, OHA's chief financial officer.
The audit also detailed ways that, under previous leadership, OHA delayed providing information or limited access to some employees during the investigation.
Managers would tell their employees not to respond directly to an auditor's follow-up questions, including questions that would take just minutes to answer, according to the report. It also indicated that auditors were directed to speak with managers who would end up having less familiarity with the information than staff.
One example the audit mentioned was when auditors requested in February a list of "carve outs" used to perform some testing, information they didn't receive for five months and was incomplete upon delivery.
But the audit also mentioned that since Robison and OHA Director Pat Allen took over in September, timeliness and access "dramatically" improved.