Increased Oversight Needed For Growing Managed Care Expenditures

In fiscal year 2013, the Medicaid program covered about 71.7 million people at a cost of $431.1 billion, of which Centers for Medicare and Medical Services (CMS) estimated that $14.4 billion (5.8 percent) were improper  payments.  In 2014, the Government Accountability Office (GAO) examined how state and federal agencies ensure comprehensive integrity efforts, such as payment review, auditing, and investigating fraud.  To improve the efficiency and effectiveness of Medicaid program, the GAO recommends that the Administrator of CMS should:

  • update its Medicaid managed care guidance on program integrity practices,
  • provide the states with additional support in overseeing Medicaid managed care program integrity, and
  • require states to audit payments to and by managed care organizations.

For additional information and complete GAO report go to http://www.gao.gov/products/GAO-13-34.

Teaching Suggestions

  • Ask students what are typical benefits that Medicaid provides.
  • Ask students to prepare a summary report on how to prevent or reduce the Medicaid fraud.

Discussion Questions

  1. What is Medicaid and how it assists low-income individuals and families?
  2. How is Medicaid financed?
  3. Do people with Medicaid need to buy supplemental medical insurance?
Categories: Chapter 9, Health Insurance | Tags: | Leave a comment

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