OIG July 11, 2018
WHY OIG DID THIS REVIEW
Managed care is the primary delivery system for Medicaid. As of 2015, it covered 80 percent of all Medicaid enrollees. Although managed care has rapidly expanded, program integrity issues have not received the same attention in managed care as they have in Medicaid fee-for-service. The Office of Inspector General (OIG) and others have ongoing concerns about program integrity in Medicaid managed care.
HOW OIG DID THIS REVIEW
We based this study on data from three sources: (1) a survey requesting 2015 data from the MCO with the largest expenditures in each of the 38 States that provides Medicaid services through managed care, (2) structured interviews with officials from five selected MCOs, and (3) structured interviews...
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