Evidence record
Medicaid Managed Care Improvements Needed to Better Oversee Payment Risks
- Publishing agency
- U.S. Government Accountability Office
- Publication date
- July 26, 2018
- Source record
- Original document linked
Findings
3
Recommendations
3
Overall conclusion
The GAO found that Medicaid managed care faces significant payment risks and oversight challenges. CMS's efforts to improve program integrity have been delayed and insufficient, risking continued payment errors and fraud. Strengthening oversight and guidance is essential to mitigate these risks.
Scope
The audit covers Medicaid managed care programs in the United States, focusing on payment risks, oversight challenges, and CMS efforts from October 2016 to July 2018.
Findings (3)
Each finding has a stable link.
- F-132
Six types of payment risks associated with Medicaid managed care, including incorrect fee-for-service payments and inaccurate state payments to MCOs.
- F-133
Challenges to program integrity oversight include resource allocation, data quality, and policy adequacy.
- F-134
CMS efforts to improve oversight have faced delays and gaps, limiting effectiveness.