Kansas Audit Flags Issues In KanCare Oversight, MCO Claim Denial

The Kansas Office of the Inspector General (IG) identified issues with the state’s KanCare Medicaid program managed by the Kansas Department of Health and Environment (KDHE) related to concerns raised by hospital provider organizations. Concerns included cost control strategies, utilization management, potential conflicts of interest, and reimbursement denials.

To assess the complaints, the Kansas IG audited utilization management and the effects on MCO reimbursements from January 1, 2021, through December 31, 2023. The managed care organizations (MCOs) were identified as Sunflower Health Plan, UnitedHealthcare Community Plan, and Aetna Better Health of Kansas.

Over a three-year period, the value . . .