GAO: Medicaid managed care needs better watchdogs

Improper payments cost Medicaid about $14.4 billion last year, and some of that loss may be due to a gap in managed care program oversight at state and federal levels, according to a report by the Government Accountability Office. State and federal agencies aren't holding Medicaid managed care organizations accountable for identifying, preventing and discouraging overpayments, the GAO found. The Centers for Medicare & Medicaid Services hasn't updated program guidance in more than a decade. And CMS doesn't require states to audit managed care payments to contractors. All this leaves federal Medicaid funds vulnerable to misspending, the report concluded. This risk is becoming more urgent with Medicaid managed care payments outpacing their fee-for-service counterparts and program expansion under the Affordable Care Act. Abstract

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