9 documentation checks to run before a Medicaid auditor asks for records

When a Medicaid reviewer flags a claim, the problem is usually a missing piece of paper, not a fake patient. Of all Medicaid improper payments in fiscal 2025, 77 percent came from insufficient documentation, according to CMS' fiscal 2025 improper payments fact sheet, which notes that the category is generally not a sign of fraud or abuse. A Congressional Research Service brief on Medicaid program integrity dated Oct. 7 repeated that figure and added that nobody knows how much Medicaid fraud there actually is.

That distinction matters less than it should once an auditor is on the phone. The Medicaid improper payment rate climbed to 6.12 percent, or $37.39 billion, in fiscal 2025, and state Medicaid fraud control units recovered almost $2 billion that year, according to the HHS Office of Inspector General's annual report on the units. With states under heavy federal pressure to show results, a claim the practice cannot support on paper gets treated as an overpayment, whether or not the care was delivered.

The good news is that the fix is mostly clerical. State audit findings point to the same handful of missing records again and again: orders, time documentation and signatures. And 17 states, including Illinois, Michigan, Ohio and Pennsylvania, are in a federal review cycle that samples claims paid from July 1, 2026, through June 30, 2027, so the claims going out this fall are fair game. Here are nine checks to run now.