Now on Demand: Compliance Oversight and Program Integrity in Medicaid Managed Care

Health Update

There is a growing trend among states to develop more rigorous methods for overseeing and enforcing contract requirements with Medicaid managed care organizations (MCOs). Many states have increased their use of liquidated damages, as well as created financial incentives for plans to make fraud referrals or to participate in fraud and abuse investigations and recovery processes. States often report, however, legislative and regulatory obstacles to exercising their authority. This trend has impacted the way MCOs must conduct oversight and has downstream effects on providers.

In a recent Manatt webinar—the third in our Medicaid managed care series—we explored the differences and similarities among states in enforcing Medicaid MCO contract requirements. We also examined expectations regarding MCOs’ participation in program integrity activities and the impact on MCOs and providers. We want to be sure you don’t miss the important information shared during the program. Key topics covered include:

  • An overview of states’ approaches to compliance oversight and program integrity of Medicaid MCOs
  • The impact of compliance oversight and program integrity on rate-setting for Medicaid MCOs
  • Barriers to states’ and MCOs’ coordinating program integrity activities
  • A discussion of how plans can prepare for increased oversight and program integrity activity—and avoid the imposition of liquidated damages
  • A look at the impact of plans’ enhanced oversight of providers
  • An analysis of how value-based purchasing may alter compliance and program integrity priorities and activities

If you have any questions or issues you’d like to discuss after viewing the webinar, please reach out to our presenters: