An examination of more than 2 million Oregon Health Plan identification records found hundreds of potential duplicate IDs and as much as $4.1 million in associated overpayments, prompting state auditors to call for stronger safeguards within an increasingly complex Medicaid eligibility system.
The audit, released by the Oregon Secretary of State’s Office, examined records from 2020 through 2024 and identified 645 potential duplicate system IDs. Auditors warned that duplicate records can result in unnecessary payments to Coordinated Care Organizations and could jeopardize federal funding if the state fails to adequately detect and correct the errors.
The financial findings represent a small portion of Oregon’s overall Medicaid expenditures but carry broader implications because of the federal requirements governing the program. During the four-year period reviewed by auditors, Oregon paid approximately $37 billion to Coordinated Care Organizations, which administer health services for Oregon Health Plan members across the state.
Approximately one-third of Oregon residents depend on Medicaid for health coverage. The Oregon Health Plan serves communities from the Portland metropolitan area and Willamette Valley to the coast, central and eastern Oregon and the southern counties, where Coordinated Care Organizations provide coverage for thousands of residents in Josephine and Jackson counties.
Because a substantial portion of Medicaid funding comes from the federal government, Oregon must demonstrate that payments are accurate and that improper expenditures are identified and recovered. Auditors cautioned that unresolved deficiencies could ultimately lead federal authorities to reduce or withhold funding.
Oregon Secretary of State Tobias Read said the Oregon Health Authority had already discovered many of the duplicate payments and recovered or adjusted them before auditors completed their examination.
“The Oregon Health Plan is a critical program that supports the wellbeing of Oregonians, which is why it must be administered efficiently, effectively, and in compliance with federal rules,” Read said. “OHA already identified many of the duplicate payments and recouped or adjusted them before our review was complete, but overpayments are still overpayments, and any lost federal funding for the Oregon Health Plan would make it more difficult to care for the Oregonians who need help the most.”
The audit found that OHA’s existing computer system has the ability to identify records that may be duplicates. Auditors concluded, however, that the technology alone is insufficient without adequate training for employees responsible for reviewing and resolving those records.
That responsibility is becoming more demanding as Oregon adjusts to changes in Medicaid eligibility procedures. Eligibility determinations that previously occurred less frequently must now be conducted every six months, according to the audit, increasing the frequency of reviews fourfold. The additional processing creates more opportunities for discrepancies if duplicate records are not recognized and corrected promptly.
Duplicate identification numbers do not necessarily mean that an individual improperly received medical care. The concern identified by auditors involves the administrative records used to calculate payments to Coordinated Care Organizations. When one person is represented by more than one system ID, the state can potentially make payments based on multiple records for the same Medicaid member.
Auditors issued five recommendations intended to strengthen OHA’s ability to detect and prevent duplicate IDs and to recover or correct payments when duplication results in an improper expenditure. Training employees to recognize potential duplicate records is among the measures auditors identified as necessary for improving the existing system.
The findings place greater emphasis on administrative accuracy at a time when Medicaid remains one of Oregon’s largest public health programs. Even relatively uncommon record duplication can translate into substantial dollar amounts when applied across a system handling millions of records and billions of dollars in payments.
The Secretary of State’s Office will return to the findings under a new audit follow-up process designed to determine whether agencies carry out recommendations after an audit is completed. Auditors are expected to review OHA’s progress on the five recommendations within the next 18 months.
For Oregon Health Plan members, including residents throughout Southern Oregon, the audit does not announce reductions in benefits or changes in available health services. Its findings instead address the administrative controls behind the program and the state’s responsibility to ensure Medicaid dollars are accurately distributed, documented and protected under federal funding requirements.