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Series: Duplicate Payments for Beneficiaries with Multiple Medicaid Identification Numbers

Announced on  | Last Modified on  | Series Number: W-00-24-31374
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

During a preliminary data match, OIG identified a significant number of individuals who were assigned more than one Medicaid identification number and for whom multiple Medicaid payments were made for the same period. We will review duplicate payments made by States on behalf of Medicaid beneficiaries with multiple Medicaid identification numbers and identify States' procedures or other controls for preventing such payments.

There are 9 projects in this series.

COMPLETED PROJECTS IN THIS SERIES (9)

Pennsylvania

Project A-04-24-07110 • Completed on July 21, 2025

New York

Project A-02-23-01017 • Completed on April 1, 2024

California

Project A-04-21-07097 • Completed on October 25, 2022

Kentucky

Project A-04-20-07094 • Completed on December 2, 2021

Texas

Project A-06-20-10003 • Completed on July 21, 2021

Duplicate Payments for Beneficiaries with Multiple Medicaid Identification Numbers - New York

Project A-02-20-01007 • Completed on May 11, 2021

Florida

Project A-04-18-07080 • Completed on March 23, 2020

New York

Project A-02-18-01020 • Completed on February 20, 2020

Tennessee

Project A-04-18-07079 • Completed on October 29, 2019

TIMELINE

  • May 15, 2018
    Series Number W-00-24-31374 Assigned
  • May 15, 2018
    Project Announced

    New York - A-02-18-01020

  • August 15, 2018
    Project Announced

    Tennessee - A-04-18-07079

  • September 15, 2018
    Project Announced

    Florida - A-04-18-07080

  • October 29, 2019
    Project Complete - A-04-18-07079

    Tennessee has been marked as complete. This audit resulted in 3 recommendations.

  • January 15, 2020
    Project Announced

    Duplicate Payments for Beneficiaries with Multiple Medicaid Identification Numbers - New York - A-02-20-01007

  • February 20, 2020
    Project Complete - A-02-18-01020

    New York has been marked as complete. This audit resulted in 3 recommendations.

  • March 23, 2020
    Project Complete - A-04-18-07080

    Florida has been marked as complete. This audit resulted in 3 recommendations.

  • July 20, 2020
    Project Announced

    Texas - A-06-20-10003

  • August 4, 2020
    Project Announced

    Kentucky - A-04-20-07094

  • May 11, 2021
    Project Complete - A-02-20-01007

    Duplicate Payments for Beneficiaries with Multiple Medicaid Identification Numbers - New York has been marked as complete. This audit resulted in 3 recommendations.

  • July 21, 2021
    Project Complete - A-06-20-10003

    Texas has been marked as complete. This audit resulted in 4 recommendations.

  • December 2, 2021
    Project Complete - A-04-20-07094

    Kentucky has been marked as complete. This audit resulted in 3 recommendations.

  • December 15, 2021
    Project Announced

    California - A-04-21-07097

  • October 25, 2022
    Project Complete - A-04-21-07097

    California has been marked as complete. This audit resulted in 5 recommendations.

  • April 26, 2023
    Project Announced

    New York - A-02-23-01017

  • February 1, 2024
    Project Announced

    Pennsylvania - A-04-24-07110

  • April 1, 2024
    Project Complete - A-02-23-01017

    New York has been marked as complete. Report Published

  • July 21, 2025
    Project Complete - A-04-24-07110

    Pennsylvania has been marked as complete. This audit resulted in 5 recommendations.

  • July 21, 2025
    Series Complete

    Duplicate Payments for Beneficiaries with Multiple Medicaid Identification Numbers has been marked as complete.

9 REPORT PUBLISHED

Tennessee Made Unallowable Capitation Payments for Beneficiaries Assigned Multiple Medicaid Identification Numbers (A-04-18-07079)

20-A-04-009.01 to CMS - Closed Implemented
Closed on 04/02/2020
We recommend that the Division of TennCare refund to the Federal Government $378,137 (Federal share) in overpayments.

20-A-04-009.02 to CMS - Closed Implemented
Closed on 04/02/2020
We recommend that the Division of TennCare review capitation payments that fell outside of our audit period and refund any overpayments.

20-A-04-009.03 to CMS - Closed Implemented
Closed on 04/02/2020
We recommend that the Division of TennCare enhance or establish new controls to ensure that no beneficiary is issued multiple Medicaid ID numbers.

View in Recommendation Tracker

Florida Made Almost $4 Million in Unallowable Capitation Payments for Beneficiaries Assigned Multiple Medicaid ID Numbers (A-04-18-07080)

20-A-04-075.01 to CMS - Closed Implemented
Closed on 10/02/2020
We recommend that the Florida Agency for Health Care Administration refund to the Federal Government $3,909,840 (Federal share) in unallowable payments.

20-A-04-075.02 to CMS - Closed Unimplemented
Closed on 02/03/2023
We recommend that the Florida Agency for Health Care Administration review capitation payments that fell outside of our audit period and refund any unallowable payments.

20-A-04-075.03 to CMS - Closed Implemented
Closed on 10/02/2020
We recommend that the Florida Agency for Health Care Administration modify its current methodology to identify beneficiaries with multiple Medicaid identification numbers.

View in Recommendation Tracker

California Made Almost $16 Million in Unallowable Capitation Payments for Beneficiaries With Multiple Client Index Numbers (A-04-21-07097)

23-A-04-006.01 to CMS - Closed Implemented
Closed on 01/25/2023
We recommend that the California Department of Health Care Services refund to the Federal Government $15,722,587 in unallowable payments.

23-A-04-006.02 to CMS - Open Unimplemented
Update expected on 03/30/2026
We recommend that the California Department of Health Care Services review capitation payments that fell outside of our audit period and refund any unallowable payments.

23-A-04-006.03 to CMS - Open Unimplemented
Update expected on 03/30/2026
We recommend that the California Department of Health Care Services ensure that the algorithm used to create its revised Beneficiary Name and DOB Match Reports is effective at detecting individuals with multiple records.

23-A-04-006.04 to CMS - Open Unimplemented
Update expected on 03/30/2026
We recommend that the California Department of Health Care Services require county staff to review training materials on the prevention of issuing multiple CINs.

23-A-04-006.05 to CMS - Open Unimplemented
Update expected on 03/30/2026
We recommend that the California Department of Health Care Services enhance its controls to ensure that no beneficiary is issued multiple CINs.

View in Recommendation Tracker

Pennsylvania Made More Than $8.7 Million in Unallowable Capitation Payments for Enrollees With Multiple Medicaid Identification Numbers (A-04-24-07110)

Pennsylvania made unallowable capitation payments on behalf of enrollees with multiple Medicaid ID numbers.

  • Of the 100 enrollee-matches in our sample, the State agency correctly made capitation payments on behalf of individuals associated with 2 enrollee-matches; however, the State agency incorrectly made capitation payments—totaling $1,068,308 ($559,087 Federal share)—on behalf of individuals associated with the remaining 98 enrollee-matches.
  • The unallowable capitation payments occurred because the State agency’s controls were insufficient to detect or prevent multiple Medicaid ID numbers from being assigned to the same enrollee.
  • On the basis of our sample results, we estimated that the State agency made unallowable capitation payments totaling at least $8,784,549 ($4,596,390 Federal share) on behalf of enrollees with multiple Medicaid ID numbers during our audit period.

25-A-04-084.01 to CMS - Open Unimplemented
Update expected on 01/20/2026
We recommend that the Pennsylvania Department of Human Services refund to the Federal Government $4,596,390 in unallowable payments.

25-A-04-084.02 to CMS - Open Unimplemented
Update expected on 01/20/2026
We recommend that the Pennsylvania Department of Human Services review capitation payments subsequent to our audit period and refund any unallowable payments.

25-A-04-084.03 to CMS - Open Unimplemented
Update expected on 01/20/2026
We recommend that the Pennsylvania Department of Human Services use the Zero SSN report consistently and update it monthly, in accordance with the State agency's policy and procedures, to prevent the issuance of multiple Medicaid ID numbers for the same enrollee.

25-A-04-084.04 to CMS - Open Unimplemented
Update expected on 01/20/2026
We recommend that the Pennsylvania Department of Human Services test the match-scoring algorithm to ensure it is working as intended.

25-A-04-084.05 to CMS - Open Unimplemented
Update expected on 01/20/2026
We recommend that the Pennsylvania Department of Human Services enhance or establish new controls to prevent, detect, and correct instances where multiple Medicaid ID numbers are assigned to the same enrollee.

View in Recommendation Tracker

New York Made Unallowable Payments Totaling More Than $10 Million for Managed Care Beneficiaries Assigned Multiple Medicaid Identification Numbers (A-02-18-01020)

20-A-02-065.01 to CMS - Closed Implemented
Closed on 01/10/2025
We recommend that the New York State Department of Health refund $11,257,368 to the Federal Government.

20-A-02-065.02 to CMS - Closed Implemented
Closed on 08/17/2023
We recommend that the New York State Department of Health identify and recover improper managed care payments made to different MCOs on behalf of beneficiaries with multiple Medicaid ID numbers prior to and after our audit period, and repay the Federal share of the amounts recovered.

20-A-02-065.03 to CMS - Closed Implemented
Closed on 07/31/2023
We recommend that the New York State Department of Health strengthen its procedures for determining whether an individual applying for Medicaid has already been assigned a Medicaid ID number by ensuring that its system queries identify all individuals with existing Medicaid ID numbers and - local district and Marketplace staff follow guidance on identifying individuals with Medicaid ID numbers and use all available resources to identify and prevent the issuance of multiple Medicaid ID numbers to the same individual.

View in Recommendation Tracker

New York Made Unallowable Payments Totaling More Than $9 Million to the Same Managed Care Organization for Beneficiaries Assigned More Than One Medicaid Identification Number (A-02-20-01007)

21-A-02-092.01 to CMS - Closed Implemented
Closed on 01/07/2025
We recommend that the New York State Department of Health refund $9,325,338 to the Federal Government.

21-A-02-092.02 to CMS - Closed Implemented
Closed on 11/03/2021
We recommend that the New York State Department of Health identify and recover improper managed care payments made to the same MCO on behalf of beneficiaries with more than one Medicaid ID number prior to and after our audit period, and repay the Federal share of the amounts recovered.

21-A-02-092.03 to CMS - Closed Implemented
Closed on 07/31/2023
We recommend that the New York State Department of Health ensure that improvements made to its processes for determining whether an individual applying for Medicaid has already been assigned a Medicaid ID number are effective by verifying that system queries are adequate to identify all individuals with existing Medicaid ID numbers and local district and Marketplace staff are following guidance on identifying individuals with Medicaid ID numbers and using all available resources to identify and prevent the issuance of more than one Medicaid ID number to the same individual.

View in Recommendation Tracker

Kentucky Made Almost $2 Million in Unallowable Capitation Payments for Beneficiaries With Multiple Medicaid ID Numbers (A-04-20-07094)

22-A-04-018.01 to CMS - Closed Implemented
Closed on 12/21/2022
We recommend that the Kentucky Cabinet for Health and Family Services refund to the Federal Government $1,894,643 (Federal share) in unallowable payments.

22-A-04-018.02 to CMS - Closed Implemented
Closed on 12/21/2022
We recommend that the Kentucky Cabinet for Health and Family Services review capitation payments that fell outside of our audit period and refund any unallowable payments.

22-A-04-018.03 to CMS - Closed Implemented
Closed on 04/14/2022
We recommend that the Kentucky Cabinet for Health and Family Services enhance or establish new controls to ensure that no beneficiary is issued multiple Medicaid ID numbers.

View in Recommendation Tracker

Texas Made Unallowable Children's Health Insurance Program Payments for Beneficiaries Assigned More Than One Identification Number (A-06-20-10003)

21-A-06-127.01 to CMS - Closed Implemented
Closed on 10/26/2021
We recommend that the Texas Health and Human Services Commission refund $856,456 to the Federal Government.

21-A-06-127.02 to CMS - Closed Implemented
Closed on 10/26/2021
We recommend that the Texas Health and Human Services Commission identify and recover additional unallowable CHIP payments made before and after our audit period for the 572 beneficiary-matches and repay the Federal share.

21-A-06-127.03 to CMS - Closed Implemented
Closed on 10/26/2021
We recommend that the Texas Health and Human Services Commission identify any other beneficiaries who are assigned more than one identification number and refund any unallowable CHIP payments associated with those beneficiaries.

21-A-06-127.04 to CMS - Closed Implemented
Closed on 10/26/2021
We recommend that the Texas Health and Human Services Commission strengthen its procedures for determining whether applicants are already enrolled in any medical or public assistance benefits throughout the State and ensure that no beneficiary is assigned more than one identification number.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Financial Stewardship Managed Care
Target Groups
-
Financial Groups
Medicaid