GAO Recommends Increased CMS Oversight Of Medicaid Managed Care Expenditures

Last month, the Government Accountability Office (GAO) recommended that the Centers for Medicare and Medicaid Services (CMS) increase its oversight of managed care organizations (MCOs), instead of focusing all its efforts on fraud and waste associated with fee-for-service (FFS). GAO recommended requiring states to audit the “appropriateness” of payments to MCOs, updating guidance on Medicaid managed care program integrity, and providing audit assistance. Currently, CMS does not require states to audit MCOs payments.

These findings were reported in “Medicaid Program Integrity: Increased Oversight Needed to Ensure Integrity of Growing Managed Care Expenditures” by the Government Accountability Office (GAO . . .