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Oregon Secretary of State Audits Division

Oregon Health Authority: Medicaid Duplicate IDs Put Federal Funding at Risk

Objective

To determine whether the Oregon Health Authority (OHA) made duplicate payments for the same recipient at the same time.

Scope

This audit focuses on Medicaid recipients who had multiple system IDs and concurrent capitation payments made from 2020 to 2024. A capitation payment is a fixed monthly amount OHA pays to Coordinated Care Organizations (CCOs) for each recipient regardless of how many services a recipient uses.

September 2026
Report 2026-26

Download the full report

 View the agency response

View the press release


Why this audit is important

In 2025, Oregon spent $19 billion on Medicaid, of which $13 billion was federally funded. One in three Oregonians rely on this important service. The federal government can reduce or withhold funding from states that are out of compliance with rules. Paying Coordinated Care Organizations multiple capitation payments for the same recipient reduces the funding available to other important programs in the state. Due to the critical nature of this program, OHA must run Medicaid efficiently, effectively, and in compliance with federal rules.

What we found

Federal funding could be at risk if OHA does not follow federal rules. (pg. 3)

One in three Oregonians rely on Medicaid for critical healthcare coverage. Medicaid is funded jointly by states and the federal government. If Oregon fails to follow federal rules, the federal government can withhold or reduce funding which makes up about two-thirds of the Medicaid budget. Though OHA has up to one year to remit the federal portion of overpayments back to the federal government, compliance is critical to maintaining funding for the program.

OHA made duplicate capitation payments for the same recipient during the same time. (pg. 3)

We performed data matches between all Medicaid recipients from 2020 to 2024 to identify potential duplicate recipients where capitation payments were made concurrently. Out of more than 2 million IDs, we identified 645 potential duplicates and tested 56 pairs of IDs. Our testing found $230,252 in overpayments. After projecting the errors to the population, we estimate OHA made between $232,000 and $4.1 million of duplicate capitation payments for the entire Medicaid program between 2020 and 2024.

Duplicate Medicaid IDs can cause data integrity issues. (pg. 5)

When one recipient has multiple system IDs assigned to them, the system data is no longer accurate and consistent. Each duplicate ID created causes the agency to spend more time and resources cleaning up the errors. Duplicates can also cause issues with reporting accurate information to the federal government and can create issues with system contractors.

What we recommend

To comply with federal regulations, OHA should:

  1. Review the other IDs that were not detail tested to determine if they are duplicates and whether overpayments occurred. Along with the tested 31 samples, remit the federal portion of the overpayments back to the federal government.

    2. Agency response: Agree
    Target completion date: October 31, 2026

On recouping overpayments to CCOs, OHA should use the capitation reconciliation process to:

  1. Recoup duplicate payments from CCOs.

    2. Agency response: Agree
    Target completion date: October 31, 2026

To better prevent and detect duplicate IDs, OHA should:

  1. Provide specific training to eligibility workers on best practices for researching applicants and potential matches.

    2. Agency response: Agree
    Target completion date: June 30, 2027

  2. Develop future system enhancements that will reduce the manual research currently performed by eligibility workers.

    3. Agency response: Agree
    Target completion date: December 31, 2028

  3. Design and implement a quality control process to better prevent and detect duplicate IDs. Included in this process should be: 
    1. A mechanism to identify capitation payments once duplicate IDs are identified; and 
    2. Using the established capitation reconciliation process, remit the federal portion of overpayments in compliance with federal regulations once they are identified.

    Agency response: Agree
    Target completion date: June 1, 2027


Agency Response

OHA agreed with all our recommendations. The response can be found at the end of the report.