In August 2023, the Office of Inspector General for the Department of Health and Human Services (OIG) declared a new strategic plan seeking to scrutinize the lifecycle of Medicare Advantage and Medicaid managed care contracts. This investigation will span from the inception of the contracts right up to their enrolment, reimbursement, services, and renewal phases.
The OIG’s plan aims to tackle risks associated with fraud, waste, and abuse. Moreover, the plan articulates the goal of holding Medicare Advantage organizations (MAOs) and Medicaid managed care organizations (MCOs) accountable. This initiative presents a considerable responsibility shift for these organizations and requires them to pay meticulous attention to potential issues that may arise as a result of this new strategy.
The action initiated by the OIG intends not only to maintain the integrity of the Medicare Advantage and Medicaid programs but also to protect the beneficiaries under these programs. This development is of high significance for both providers and enrollees of MAOs and MCOs, as the examining procedure by the OIG may significantly impact the operational aspects of these organizations.
For further information on the subject, please refer to the article
OIG Enhanced Review: OIG to Investigate the Life Cycle of Managed Care Contracts by Venable LLP.