Audit Shows Medicaid Recipients Not Properly Vetted

The state auditor and inspector just wrapped up an investigation into the Oklahoma Healthcare Authority. And the results are shocking.

The Oklahoma Healthcare Authority oversees Medicaid and the Children’s Health Insurance Program, helping provide health care coverage to about a million low income Oklahomans. But a large percentage of those Oklahomans are not going through the proper screening to determine whether they’re eligible. 

“During the audit period income was not verified for approximately 37% of the Medicaid assistance program claims, also referred to as MAP, and 28% of the children’s health insurance program,” said State Auditor and Inspector Cindy Byrd.

During a press conference Thursday, Byrd released her offices findings of an audit of the 2019 books.

“When income is not verified you have no idea if the recipient is eligible. A lack of safeguards leaves an unknown,” Byrd said.

In terms of dollars and cents, almost $30 million was paid out for Oklahomans who were ineligible, and because of incomplete records, another $845 million was paid out when the eligibility of the recipient was not verified.

“This does not mean the claims were paid on behalf on ineligible recipients. It means that we were unable to determine if Medicaid benefits should have been paid.” Byrd said.

From here the Health Care Authority plans to incorporate data exchange sources to cross-verify the income of applicants.

“IRS, tax commission, credit bureaus and others that will allow us to again have more confidence in the verification process of income,” said Oklahoma Healthcare Authority Director Kevin Corbett.

“I think it’s really great news that we’ve got the facts out there. That’s what you want. You want to get the facts so you can make the right decisions and then put the team in place to correct any errors,” Governor Kevin Stitt added.

Those data exchange sources can be costly, but the Healthcare Authority said they’ll be paid for through savings from properly verifying applicants incomes.