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Oregon made as much as $4 million in overpayments to administrators of its Medicaid system between 2020 and 2024 because some people had multiple Oregon Health Plan IDs.
That’s according to an audit published Wednesday by the Oregon Secretary of State’s Office. Though the figure is a tiny fraction of all Oregon Medicaid spending—which the state says totaled roughly $60 billion in that span—the audit flagged the issue as consequential because the federal government, which supplies most of that money, could withhold payment if the state fails to follow its rules.
Audits in other states have found this to be a risk area too, Secretary of State Tobias Read’s office says. The Oregon Health Authority, which runs the Medicaid program, says it accepted the audit’s recommendations, which include recouping the duplicate payments that went out to organizations that administer Medicaid plans throughout the state and remitting the federal portion back to the feds.
“The Oregon Health Plan is a critical program that supports the well-being of Oregonians, which is why it must be administered efficiently, effectively, and in compliance with federal rules,” Read said in a written statement.
The audit released Wednesday concerned payments made to coordinated care organizations that manage Oregon Health Plan benefits for most of the 1.4 million Oregonians enrolled. (In Portland, for example, you might get OHP benefits through CareOregon, which operates on behalf of a CCO here.)
The state paid $37 billion to CCOs between 2020 and 2024, the audit said. Much of this funding is paid out on a per member basis.
This structure sits at the heart of the audit. When there are duplicate IDs—of which the audit said it found as many as 645—CCOs may get a phantom extra member on the rolls. And this would mean the CCO gets paid more than it should since it won’t have to pay anything for that phantom person’s health care.
The audit says duplicates may in some cases occur when someone who forgets they have OHP benefits applies again. The state has a system in place to identify full and partial duplicates during the application process, but the audit says it found flaws in the system where it did not catch matches it should have.
And it added that the control only works if eligibility workers are adequately trained to research potential matches when the notice appears. The audit says that, in addition to recouping the duplicate payments from CCOs, OHA should train eligibility workers to weed out duplicates, improve its eligibility system to reduce manual research that workers have to do, and come up with a system for quality control.
There are various avenues by which to apply for OHP eligibility. The audit found that duplicates disproportionately entered the system via applications made through certified community partners, third-party organizations and people that help Oregon residents, with a focus on cultural and linguistic outreach to “communities facing disproportionate barriers to health coverage and health-related resources.”
The audit says these third-party partners “have cited access barriers and inconsistent information given by applicants as reasons why it can be challenging to help Oregonians apply for benefits.”
The audit says it performed data matches between all Medicaid recipients from 2020 to 2024 to identify potential duplicate recipients where capitation payments to CCOs were made concurrently.
Out of more than 2 million IDs, it identified 645 potential duplicates and tested 56 pairs of IDs. The testing found $230,252 in overpayments. After projecting the errors to the population, it estimates OHA made between $232,000 and $4.1 million of duplicate capitation payments for the entire Medicaid program between 2020 and 2024.
The audit comes months after a separate report by Read’s office pointed out flaws in the system used to screen OHP eligibility.
It also comes as a federal law kicks in that will heighten OHP eligibility requirements for many Oregonians, and require the state to generally check OHP member eligibility every six months, as opposed to the status quo of two years.
And it comes as the Trump administration has made a show of scrutinizing public benefit programs that benefit low-income people for waste, fraud and abuse.
In a letter, OHA interim Medicaid director Vivian Levy said the agency was concerned with the title of the new audit—“Medicaid Duplicate IDs Put Federal Funding at Risk.”
She wrote that the agency works “diligently through robust, established processes to recover and return monies, as appropriate, under the federal program guidelines. While limited duplicate capitation payments may occur, OHA is committed to correcting any duplication errors and recouping the capitation payments.”
