AHCA making progress but stronger detection, sanctions, and managed care oversight needed (Report No. 08-08)

Shafer, Kim; O’Dare, Kellie; Witgert, Kathy

AHCA making progress but stronger detection, sanctions, and managed care oversight needed (Report No. 08-08)

Shafer, K., O’Dare, K., & Witgert, K. (2008). AHCA making progress but stronger detection, sanctions, and managed care oversight needed (Report No. 08-08). Office of Program Policy Analysis & Government Accountability (OPPAGA).

Details

Title: AHCA making progress but stronger detection, sanctions, and managed care oversight needed (Report No. 08-08)
Contributor(s): Shafer, Kim (author)
O’Dare, Kellie (author)
Witgert, Kathy (author)
Located In: Office of Program Policy Analysis & Government Accountability (OPPAGA)
Date: 2008
Abstract: Since our 2006 review, AHCA has taken steps we recommended to improve performance reporting and to strengthen its ability to safeguard the state against provider waste, abuse, and fraud in the Medicaid program. However, AHCA has not implemented our recommendations to develop a sustainable advanced detection system using artificial intelligence and to strengthen its sanctioning process by establishing fines that represent a minimum percentage of identified overpayments. While AHCA has strengthened its oversight of Medicaid managed care organizations, more steps are needed to deter and detect corporate level abusive and fraudulent practices.