PER-2014-4445

The results of our audit disclosed deficiencies in internal control that are considered reportable under Government Auditing Standards. Specifically, the Division did not have adequate documentation and evidence to support approving 65% of higher risk providers during calendar year 2012. In addition, the Division's Contractor's enrollment review procedures allowed a 30% error rate in performing and documenting mandatory verification checks. These deficiencies in the Medicaid Provider enrollment process increase the risk of unqualified providers participating in the Medicaid Program. Further, the contract for provider enrollment lacks adequate performance measures to hold the Contractor accountable for processing applications accurately and reliably. The Department of Health and Human Services generally agreed with our findings and recommendations, however, an auditor's response was necessary to clarify certain statements in the Department's response. Details about each item are provided in the Audit Findings, Recommendations and Responses section of the report.