The audit, published July 19, reviewed a sample of 100 payments the program made from 2019 to 2021. Based on the sample, Virginia’s Medicaid program paid $76,939 in unallowable capitation payments.
Based on the sample, the OIG estimated the program paid $21.8 million for 12,054 deceased enrollees during the audit period.
According to the audit, the program did not have proper controls in place to identify deceased enrollees and cancel their enrollment.
The OIG recommended Virginia repay the federal government $15.7 million, the federal government’s share of the $21.8 million in overpayments. The watchdog also recommended the state recover and identify additional overpayments and take steps to develop automated matching and enrollment processes.
Virginia did not indicate if it concurred with the recommendations in its response to the audit. The state is taking actions to address the recommendations, according to the audit, including reconciling data, implementing supervisory review, closing enrollments and recovering overpaid funds.
