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Where To Report Waste Fraud, Abuse, Or Retaliation

Puerto Rico Claimed More Than $500 Thousand in Unallowable Medicaid Managed Care Payments for Enrollees Assigned More Than One Identification Number

Submitting OIG: 
Department of Health & Human Services OIG
Date Issued: 
Friday, September 8, 2023
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-02-21-01004
Component, if applicable: 
Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services
External entity, if applicable: 
Puerto Rico Department of Health
Location(s): 
PR,
United States
Type of Report: 
Audit
Questioned Costs: 
$516,762
Funds for Better Use: 
$0
Number of Recommendations: 
3
Report updated under NDAA 5274: 
No
View Document: 
AttachmentSize
PDF icon 22101004.pdf3.72 MB

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
23-A-02-109.01 Open No
We recommend that the Puerto Rico Department of Health refund $516,762 to the Federal Government.
23-A-02-109.02 Open No
We recommend that the Puerto Rico Department of Health strengthen its process for ensuring that no person is issued more than one identification number.
23-A-02-109.03 Open No
We recommend that the Puerto Rico Department of Health establish policies and procedures with the Puerto Rico Health Insurance Administration (referred to in Spanish with acronym ASES) to ensure ASES recovers unallowable payments made on behalf of enrollees assigned more than one identification number.
Displaying 3 of 3 Recommendations