Report: OHA falls short on fixing Medicaid payment problems

The secretary of state's office says the Oregon Health Authority still needs to strengthen its efforts to detect and avoid improper Medicaid payments.

Posted: Mar 27, 2019 11:46 AM
Updated: Mar 27, 2019 12:01 PM

SALEM, Ore. (AP) — The secretary of state's office says the Oregon Health Authority still needs to strengthen its efforts to detect and avoid improper Medicaid payments.

The office's audit division on Wednesday released a follow-up report to a 2017 audit that found widespread problems in the Health Authority's payment system for Medicaid.

OHA responds to 2017 audit by the Secretary of State's office:

"The audit recognizes several existing, effective processes within OHA and includes several recommendations for improvement. While we agree with the final recommendations and have already begun implementing some of them, we do not agree with some of the audit team’s estimates, underlying assumptions, and conclusions about Medicaid payments.

"For example:

We dispute the characterization of $88 million in payments to provide health coverage for 115,000 vulnerable children and adults as 'avoidable.' (In the wake of the Cover Oregon failure, federal officials approved delaying their eligibility renewals and were regularly briefed on Oregon’s progress to renew them.)
We do not agree with the conclusion that the audit identified 31,300 “questionable” payments. A sample check of 2,700 of the transactions showed that more than 98 percent of these payments were appropriately paid.

"These, and other points, are explained in more detail in the OHA response to the audit."

– Laura Robison, chief financial officer, OHA

The Statesman Journal reports that auditors found that two of the eight recommendations in the audit have been put in place and six recommendations have been partially implemented.

OHA officials agreed with all the recommendations.

The original 44-page audit, released in November 2017, found problems such as poor management of payment and eligibility issues and a lack of an agency-wide process to detect improper payments.

At the time, auditors also found the agency had about $88 million in avoidable expenses because of its backlog in determining eligibility for Medicaid recipients. Medicaid provided health insurance benefits to about one million low-income Oregonians in 2017.

In January, Health Authority officials reported they had recovered about $42 million overpaid to organizations that coordinate Medicaid benefits.

CLICK HERE for more on the story of OHA recovering $42 million in Medicaid overpayments.

Recommendations not yet fully put in place vary.

The new report found that the authority has developed systemic controls for the Medicaid Management Information System, but still lacks an adequate understanding of how they work.

The agency is taking steps to hire a contractor to test the controls' effectiveness and report the results quarterly, the report said.

On another front, the agency hasn't yet clarified Oregon administrative rules to hold Medicaid providers accountable for improper payments. OHA has identified areas for improvements, but still needs to finish the rule-making process, the report said.

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