Kansas Audit Flags KanCare MCOs For Denying Claims Totaling Over $3 Billion In 2023

Three Kansas Medicaid managed care organizations (MCOs) denied claims totaling over $3 billion in 2023, according to an audit report by the Kansas Office of the Inspector General (IG). The audit was conducted to assess complaints by hospital provider organizations about the cost control strategies, utilization management, potential conflicts of interest, and reimbursement denials of the MCOs. 

The Kansas IG audited utilization management and the effects on MCO reimbursements from January 1, 2021, through December 31, 2023. The MCOs during this period were Sunflower Health Plan, UnitedHealthcare Community Plan, and Aetna Better Health of Kansas. 

In 2023, the value of . . .