Audit finds Oregon Health Authority plagued by improper payments
SALEM, Ore. (AP) — The Oregon Health Authority misspent millions of dollars by providing Medicaid benefits to people who were ineligible, according to a results of a new audit made public Wednesday.
The audit from Secretary of State Dennis Richardson's completed a month ago found that 115,000 Medicaid recipients had not had their eligibility evaluated within the one-year federal time limit. Of those, nearly 50,000 were found to be ineligible for the benefits that were paid for them.
Reasons for their ineligibility included making too much money, moving out of state or failing to respond to state inquiries.
Oregon's annual 9.3 billion Medicaid program provides health care coverage to low-income adults, children, pregnant women, elderly adults and people with disabilities.
The number of Oregonians who rely on the program soared from 600,000 to a million following passage of the Affordable Care Act, and the health authority has had trouble keeping track of eligibility and overpayments.
In its report, the audit team said that preventing improper payments is a more cost-effective strategy than attempting to recover them. Richardson, meanwhile, blasted the agency's previous leadership team for failing to fully cooperate with auditors.
"Today's OHA Audit Report provides the best information the audit team could obtain from OHA's previous uncooperative leadership and administration," he said in a statement. "The amount of wasteful and incompetent spending at OHA has been staggering and has gone on for at least the past four years."
Laura Robison, the agency's new chief financial officer disputed some of the findings but said the health authority can do better and will implement the audit team's eight recommendations to improve efficiency and accuracy.
Regarding Medicaid recipients who didn't have their eligibility checked in a timely manner, Robison pointed out that the federal government granted a delay after the failure of the Cover Oregon health insurance exchange.
"While OHA has successfully expanded health coverage to more than 400,000 Oregonians and saved taxpayers $1.3 billion in health care costs, the effort to meet these challenges (as well as respond to the Cover Oregon failure) has not allowed us to build a foundation of consistent operational rigor and accountability in our Medicaid operations," Robison said in a statement.
The audit comes after newspaper reports that the state overbilled the federal government for certain Medicaid patients and had other accounting problems. Those issues were not included in the audit.