HHS OIG cites flawed efforts to prevent fraud in Medicaid managed care

Dive Brief:

• A new HHS Office of Inspector General report found that managed care organizations (MCOs) and states can do more to stop billions of dollars lost to fraud, waste and abuse.
• Some MCOs aren’t using proactive data analysis, which the report called a “critical tool for fraud identification.” They also referred few cases of suspected abuse to states in 2015.
• MCOs additionally didn’t inform states of suspected fraud or abuse involving providers. This includes when payers terminated provider contracts because of fraud or abuse.

OIG reviewed 2015 data from MCOs with the largest expenditures in each of the 38 states with Medicaid managed care programs. Investigators also interviewed...

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