Finding Number 2023-054
U.S. Department of Health and Human Services
Children’s Health Insurance Program (CHIP), 93.767
Medicaid Cluster:
State Medicaid Fraud Control Units, 93.775
State Survey and Certification of Health Care Providers and Suppliers (Title XVIII) Medicare, 93.777
Medical Assistance...
Finding Number 2023-054
U.S. Department of Health and Human Services
Children’s Health Insurance Program (CHIP), 93.767
Medicaid Cluster:
State Medicaid Fraud Control Units, 93.775
State Survey and Certification of Health Care Providers and Suppliers (Title XVIII) Medicare, 93.777
Medical Assistance Program (Medicaid; Title XIX), 93.778
Summary of Finding: PARIS data was not utilized by the Division of Health Care Financing and Policy (DHCFP) or the Division of Welfare and Supporve Services (DWSS) to monitor residency changes to determine when managed care benefits needed to be terminated because the beneficiary was a resident of another state for Medicaid purposes.
DHCFP and DWSS did not have internal controls in place to effectively communicate the PARIS data between the two agencies to ensure managed care benefits were terminated when appropriate.
Projected questioned costs are $11,108,851 for Medicaid and $139,223 for CHIP.
We recommend DHCFP and DWSS implement internal controls to effectively communicate the PARIS data between each other and to ensure managed care benefits are terminated when appropriate.
NVHA Response: The Nevada Health Authority agrees with this finding.
Corrected Action Planned:
The Division of Social Services (DSS) is in the process of automating the PARIS process. The automation is designed to streamline the quarterly PARIS process. Upon receipt of the file, the system generates initial requests for information to customers identified, requiring them to confirm Nevada residency. Customers are allowed 30 days to respond. Approximately five days after the initial request, reminder notices are issued by text message and email to customers who have not responded. Customers who fail to respond within the 30-day timeframe, or who confirm an out-ofstate address, will be terminated in accordance with policy, while those confirming Nevada residency will retain eligibility
Anticipated Completion Date of Corrective Action Plan : September 2025