For its audit, OIG reviewed a random sample of 150 newly eligible beneficiaries and their supporting documentation to determine whether California paid for services administered to ineligible recipients.
OIG found 112 of the 150 Medicaid beneficiaries sampled were eligible for the program, while 38 may have not been. The agency estimated California made $738.2 million in Medicaid payments on behalf of 366,078 ineligible beneficiaries, and another $416.5 million on behalf of 79,055 potentially ineligible beneficiaries.
OIG said California’s eligibility determination systems and caseworkers didn’t properly flag ineligible beneficiaries, leading to the errors.
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