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Virginia Made Capitation Payments to Medicaid Managed Care Organizations After Enrollees' Deaths

Submitting OIG: 
Department of Health & Human Services OIG
Date Issued: 
Wednesday, July 19, 2023
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-03-22-00203
Component, if applicable: 
Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services
External entity, if applicable: 
Virginia Department of Medical Assistance Services
Location(s): 
VA,
United States
Type of Report: 
Audit
Questioned Costs: 
$37,551,985
Funds for Better Use: 
$0
Number of Recommendations: 
5
Report updated under NDAA 5274: 
No

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
23-A-03-090.01 Open No
We recommend that the Virginia Medicaid Department of Medical Assistance Services refund $15,702,584 to the Federal Government.
23-A-03-090.02 Open No
We recommend that the Virginia Medicaid Department of Medical Assistance Services identify and recover unallowable capitaiton payments, which we estimate to be at least $21,849,401, made to MCOs during our audit period on behalf of deceased enrollees.
23-A-03-090.03 Open No
We recommend that the Virginia Medicaid Department of Medical Assistance Services identify and recover unallowable capitation payments made on behalf of deceased enrollees in 2018 and 2022 (the years before and after our audit period) and repay the Federal share of amounts recovered.
23-A-03-090.04 Open No
We recommend that the Virginia Medicaid Department of Medical Assistance Services continue to pursue development and implementation of an automated matching and eligibility update process.
23-A-03-090.05 Open No
We recommend that the Virginia Medicaid Department of Medical Assistance Services implement additional supervisory review to ensure that State agency personnel completely and accurately update the State agency's eligibility system based on information provided by the Virginia Department of Health's Office of Vital Statistics.
Displaying 5 of 5 Recommendations