In a report published June 28, the Congressional watchdog office recommended CMS study if it is cost effective to require states to audit Medicaid managed care plans for potential overpayments.
The Medicaid Recovery Audit Contractor program requires states to hire contractors to audit for potential Medicaid overpayments. Just 16 states participate in the program — other states have been provided exemptions from CMS because they have other audit strategies in place, or they run payments primarily through managed care.
Adding managed care programs could recover more overpayments for the federal government, the GAO wrote.
“States that have elected to use recovery audit contractors to review managed care have reported collecting overpayments, including one selected state that reported collecting more than $177 million in overpayments in [one] year. This suggests that RACs’ review of managed care claims could result in recoveries,” the GAO said in the report.
Read the full report here.
