The OIG has released a report on calculation of Medicaid inpatient hospital cost outlier payments in eight states (Georgia, Illinois, North Carolina, Ohio, New York, Pennsylvania, Virginia, Texas) that previously were the subjects of OIG audits. The OIG concludes that the state agencies did not calculate Medicaid outlier payments to effectively limit the payments to extraordinarily high-cost cases in FYs 2004-2006. The OIG recommends that CMS encourage all state agencies that make Medicaid outlier payments to (1) use the most recent cost-to-charge ratios to calculate Medicaid outlier payments, (2) reconcile Medicaid outlier payments upon cost report settlement or use an alternative method to ensure that outlier payments are more closely aligned with actual costs, and (3) amend their state plans accordingly.