The Centers for Medicare & Medicaid Services (CMS) isn’t doing enough to prevent payment risks in Medicaid managed care organizations (MCOs), according to a new report from the Government Accountability Office (GAO).
According to the report (PDF), CMS hasn’t initiated a single audit in the last two years. The absence of audits is likely tied to the fact that state MCO contracts often lack provisions around the identification of overpayments. MCO officials also blamed “a lack of consistent guidance” from states, and one state auditor said sanctions against MCOs were used infrequently.
Source: GAO audit finds CMS oversight of $171B in Medicaid managed care payments lacking / Fierce Healthcare