Office of the Inspector General Post-Payment Review

The Office of the Inspector General (OIG) has updated its operating procedures for post-payment auditing and review of claims. To assist the OIG staff locate relevant state and federal law, OIG developed a set of tools called the “Comment Grids.” These grids list some potential audit findings that could be discovered during a case review and may be used to assist staff with identifying applicable statutes and administrative code provisions. These grids do not provide an exhaustive list of potential audit findings, and do not identify all Medicaid requirements providers must meet.

These grids include the following information:

• Audit Finding: Identifies the type or category of audit finding.
• Comment: Provides a general statement identifying the basis for the audit finding.
• Description: Provides a more detailed explanation of the audit finding.
• Wisconsin Administrative Codes: Identifies a non-exhaustive list of administrative codes used to support the audit finding.
• Wisconsin State Statutes: Identifies a non-exhaustive list of state statutes used to support the audit finding.
• Revision Date: The date that the comment grid was last revised and published online.

The grids are an evolving tool and will be updated to reflect any changes to federal or state law, or auditing practices. OIG may conduct post-payment reviews of service providers and provider types not listed in these grids. The findings and related content detailed within the grids are not exhaustive, and OIG may reference other findings and/or law or code provisions according to the specific facts of a post-payment review.

These grids may be used by service providers and the public as to better understand the operational work of OIG. Service providers are required to abide by all state and federal laws and regulations. These grids are not to be used by service providers as a checklist, legal advice, or exhaustive resource to ensure compliance with Medicaid requirements.

Comment Grids by Provider Type