The State Auditor’s Office is pleased to provide an update on our performance audit of Washington’s Medicaid managed care program. During our preliminary analysis, we identified areas with the highest potential risk for overpayments that are likely to increase the state’s costs, including the following examples:

·      Providers with higher-than-usual rates of procedures with complications that could indicate over-billing.

·      Brief hospital stays of less than a day that should have been billed as outpatient services instead of more expensive inpatient services.

·      Patients with many prescriptions, or prescriptions taken over a long period of time, that may indicate abuse of prescription drugs.

We will drill down in the above areas and test a sample of claims for overpayments. If improper payments occurred, we will review what caused them and estimate the extent to which they increased the state’s costs.

You will find the audit overview here or at our website at sao.wa.gov. Our audit will be completed by September 2013.