25-A-07-044.01 to CMS - Open Unimplemented
Update expected on
03/30/2026
We recommend that the Colorado Department of Health Care Policy and Financing refund $6,012,198 to the Federal Government, consisting of $3,509,358 (Federal share) of capitation payments made on behalf of deceased enrollees who had a date of death recorded in SSA's DMF but not in the State agency's eligibility system; $293,890 (Federal share) of capitation payments made on behalf of deceased enrollees who had a date of death recorded in SSA's DMF and in the State agency's eligibility system; and $2,208,950 (Federal share) in other Medicaid expenditures that the State agency had previously overreported.
25-A-07-044.02 to CMS - Open Unimplemented
Update expected on
03/30/2026
We recommend that the Colorado Department of Health Care Policy and Financing identify and recover unallowable capitation payments made to MCOs during our audit period on behalf of deceased enrollees who did not have a date of death recorded in the State agency's eligibility system but who did have a date of death recorded in the DMF, which we estimate to be at least $6,737,760.
25-A-07-044.03 to CMS - Open Unimplemented
Update expected on
03/30/2026
We recommend that the Colorado Department of Health Care Policy and Financing recover unallowable capitation payments totaling $582,406 that were made to MCOs during our audit period on behalf of deceased enrollees who did have a date of death recorded in the State agency's eligibility system.
25-A-07-044.04 to CMS - Open Unimplemented
Update expected on
03/30/2026
We recommend that the Colorado Department of Health Care Policy and Financing identify and recover unallowable capitation payments made on behalf of deceased enrollees after our audit period and repay the Federal share of any amounts recovered.
25-A-07-044.05 to CMS - Closed Implemented
Closed on
06/10/2025
We recommend that the Colorado Department of Health Care Policy and Financing strengthen internal controls, to include strengthening policies and procedures on identifying and verifying date-of-death information, so that the State agency's eligibility system is updated based on information provided by data sources, and that capitation payments that have been made on behalf of verified deceased enrollees are recovered.
25-A-07-044.06 to CMS - Open Unimplemented
Update expected on
03/30/2026
We recommend that the Colorado Department of Health Care Policy and Financing strengthen policies and procedures for the accurate reporting of all Medicaid expenditures to CMS, to include strengthening the State agency's procedures for the routine reconciliation of information provided by the State agency's fiscal data vendor, so that only actually incurred Medicaid expenditures are reported on the Forms CMS-64 to CMS.
View in Recommendation Tracker
