Evidence record
Medicaid Managed Care Contract Monitoring Follow-Up and Oversight of Health Plan Complaint and Grievance Handling Operational Audit
- Jurisdiction
- Florida
- Publishing agency
- Florida Auditor General
- Publication date
- October 2023
- Source record
- Original document linked
Findings
1
Recommendations
1
Overall conclusion
The audit identified deficiencies in internal controls related to ECGA reporting, data summaries, and follow-up actions, indicating a need for strengthened oversight and documentation.
Scope
This audit focused on Medicaid Managed Care contract monitoring follow-up and oversight of health plan complaint and grievance handling, examining activities from July 2021 through January 2023, with testing of ECGA reports and related compliance actions from July 2021 through January 2023 and management actions through July 2023.
Findings (1)
Each finding has a stable link.
- F-920
Agency controls over Medicaid Managed Care health plan complaint, grievance, and appeal data reports and the preparation of compliance action forms need improvement, including lack of CCU Supervisor quality review documentation, incomplete reporting of noncompliance issues, and inconsistent use of Compliance Action forms.
Recommendations (1)
- R-808
Enhance policies and procedures to require supervisory review of ECGA Data Summary Reports and ensure that Compliance Action forms are prepared for all noncompliance issues noted in accordance with Agency policies and procedures.
Related finding F-920