 Audit: To Preserve Federal Funding, OHA Must Do More to Prevent Duplicate Medicaid IDs
SALEM, OR — Duplicate IDs within the Oregon Health Plan can lead to overpayments to Coordinated Care Organizations, which, if not addressed, can risk a reduction or withholding of federal funding for this critical program, auditors found.
In an audit released today, Oregon Secretary of State auditors report that between 2020 and 2024 they identified 645 potential duplicate system IDs out of more than 2 million reviewed, and associated overpayments of up to an estimated $4.1 million.
In that same time frame, the state paid $37 billion in payments to Coordinated Care Organizations. One in three Oregonians rely on Medicaid for access to health care, and much of the program is federally funded.
“The Oregon Health Plan is a critical program that supports the wellbeing of Oregonians, which is why it must be administered efficiently, effectively, and in compliance with federal rules,” Oregon Secretary of State Tobias Read said. “OHA already identified many of the duplicate payments and recouped or adjusted them before our review was complete, but overpayments are still overpayments, and any lost federal funding for the Oregon Health Plan would make it more difficult to care for the Oregonians who need help the most.”
Auditors concluded that while the system used by the agency can identify potential duplicates, adequate worker training is necessary for the system to be more effective.
Improving staff training is particularly important with recent changes to Medicaid that require eligibility to be redetermined every six months, four times more frequently than had been required.
Auditors made five recommendations to improve the detection and prevention of duplicate IDs, and, if incorrect payments do occur because of duplicate IDs, to quickly correct overpayments. As part of Secretary Read’s new audit follow-up plan, auditors will review the agency’s progress on implementing these recommendations within the next 18 months.
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