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South Carolina Did Not Report Approximately $108.6 Million of the Federal Share of Medicaid and CHIP Collections Subject to the Increased COVID-19 Federal Medical Assistance Percentage

Wisconsin May Have Improperly Claimed $455 Million in Medicaid Reimbursement for Its School-Based Program

Tennessee Claimed Federal Medicaid Reimbursement for Millions of Dollars in Targeted Case Management Services That Did Not Comply With Federal and State Requirements

Georgia Medicaid Fraud Control Unit: 2024 Onsite Inspection

New York Made Unallowable Managed Care Capitation Payments on Behalf of Incarcerated Medicaid Enrollees

Medicaid Managed Care: CMS’s Accuracy Check Process For State-Submitted Medical Loss Ratio Data Has Limitations

Alabama Medicaid Fraud Control Unit: 2025 Inspection

California Did Not Report and Return All Medicaid Overpayments for the State’s Medicaid Fraud Control Unit Cases

CMS Could Improve Oversight of States' Use of Contract Surveyors for Nursing Home Surveys

North Dakota Medicaid Fraud Control Unit: 2025 Inspection

Arizona Did Not Ensure That Selected Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization

New York Did Not Ensure That Selected Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization

Health Share of Oregon Did Not Always Comply With Federal and State Requirements When Denying Prior Authorization Requests

Kansas Did Not Ensure That Its Medicaid Managed Care Organizations Complied With Mental Health and Substance Use Disorder Parity Requirements Related to Prior Authorization

Connecticut Generally Claimed Medicaid Reimbursement for Clinical Diagnostic Laboratory Services in Accordance With Federal and State Requirements

Georgia Claimed at Least $26.1 Million More in Medicaid Reimbursements for Clinical Diagnostic Laboratory Services Than Was Allowed by Federal and State Requirements

Colorado Could Improve Its Electronic Visit Verification System and Claimed Federal Medicaid Reimbursement for Millions of Dollars in Personal Care Services That Did Not Comply With Federal and State Requirements

States Have Missed Some Opportunities to Improve Medicaid Managed Care Organizations’ Provider Fraud Referrals

New York Should Improve Its Oversight of Nursing Homes’ Compliance With Background Check Requirements

Florida Medicaid Fraud Control Unit: 2025 Inspection

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