OHA Medicaid Follow-up Report Shows Heartening Progress in Implementing Audit Recommendations

Note:

Secretary of State Dennis Richardson’s vision was bringing transparency, accountability, and integrity to Oregon government through servant leadership. By implementing nationally recognized best practices, the Secretary of State has become the center of excellence to serve all Oregonians. One way Dennis sought to promote transparency and accountability was through regular newsletter updates on important issues occurring in your government. This is a tradition we will continue in his honor.


I’m pleased to share with you an auditing success story. Auditors identified a major problem, state leadership acted quickly, and today auditors verified that the agency has processes in place to address it. As a result, Oregon is saving an estimated $12.6 million each month.

This was a direct result of Secretary of State Dennis Richardson’s leadership on transparency, accountability, and integrity.

In May of 2017, Secretary of State auditors issued an Auditor Alert informing taxpayers of a serious matter affecting Oregon’s bottom line: the Oregon Health Authority (OHA) was failing to re-determine the eligibility of thousands of Medicaid recipients in a timely manner. As a result, Oregon unnecessarily spent tens of millions of dollars on behalf of individuals eventually deemed ineligible for Medicaid.

OHA operates Oregon’s Medicaid program, known as the Oregon Health Plan, which is one of Oregon’s most important and expensive programs. We revisited this problem with our November 2017 audit report, “Oregon Health Authority Should Improve Efforts to Detect and Prevent Improper Medicaid Payments.” That report included eight recommendations to OHA, one of which dealt with the lack of eligibility oversight. At the time, Secretary of State Dennis Richardson wrote that public disclosure was the first of many steps OHA needed to take to improve transparency, efficiency, and accountability to Oregon taxpayers.

Today, I am pleased to share that thanks to our auditors who identified the problem, and the hard work of OHA and state leadership, significant progress has been made to address findings and several of the other risk areas identified in our 2017 audit report.

Our recommendation follow-up report released today shows OHA has fully implemented two recommendations and partially implemented the remaining six. One of those fully implemented recommendations stemmed from the early 2017 Auditor Alert in that OHA has developed a monthly reconciliation process to identify those who need their Medicaid eligibility re-determined. That this process now occurs on a monthly basis is essential to maintaining the integrity of the payment system. Previous delays in confirming eligibility for thousands of Medicaid recipients resulted in millions of dollars being misspent. From March to September of 2017, OHA unnecessarily paid an estimated $88 million on behalf of individuals who were eventually deemed ineligible to receive Medicaid funding.

Furthermore, despite knowing the problem existed in 2016, the OHA management team in place at the time failed to disclose this issue during the 2017 legislative session—until our auditors brought it to light.

Without the transparency encouraged by the Secretary of State’s audit work, these payments could have continued unchecked, costing taxpayers an estimated $12.6 million per month. In fact, the Audit Alert was so successful in preventing wasteful spending it won a national award for excellence in auditing.

Since November 2017, Governor Brown has directed OHA to submit regular reports detailing how the agency plans to address and resolve emerging and ongoing issues. OHA has complied, reporting regularly through 2018 and 2019.

I am pleased to see OHA leadership is taking seriously the issues auditors identified in the 2017 audit report and continues working to address legacy systems and people needing re-determinations. As a result of their hard work in implementing the audit recommendations, valuable Medicaid dollars are being more efficiently spent on those Oregonians who truly need it.

Successful outcomes that make Oregon a better place were the driving force behind Secretary Richardson. We in the Secretary of State’s office are all so proud to be a part of seeing his legacy of transparency, accountability, and integrity live on through continuing the hard work he inspired.

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