Department of Human Services
Healthcare Provider Payment Controls
Information Technology Audit
Financial Audit Division Report 10-34
Released November 4, 2010
The Department of Human Services had generally adequate internal controls to ensure it made Medical Assistance payments for allowable procedures and at authorized amounts. However, the department's internal controls were not adequate to ensure it only paid eligible providers. We consider this to be a material weakness in the department's internal controls.
The Department of Human Services resolved one and partially resolved another prior audit finding relevant to the scope of this audit. The department had not fully resolved a weakness related to limiting employee access to the Medical Assistance system.
- The Department of Human Services did not have adequate internal controls to ensure that it only paid licensed healthcare providers.
- The Department of Human Services did not adequately separate incompatible duties in its process for enrolling service providers.
- Prior Finding Partially Resolved: The Department of Human Services did not have sufficient controls to limit, monitor, or prevent incompatible or unnecessary access to the Medical Assistance system and the cash and food benefits system.
Audit Objectives and Scope
The audit objectives were to answer the following questions:
- Were the department’s internal controls in the Medical Assistance system adequate to ensure that payments were made to eligible healthcare providers for allowable procedures at the authorized price, in compliance with federal and state legal requirements?
- Were the department’s internal controls adequate to ensure payments made by the state’s accounting system agreed with payments authorized by the Medical Assistance system?
- Did the department resolve the two prior information technology findings that are relevant to the scope of this audit?
Our audit scope was July 1, 2009, through April 30, 2010.