Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued a report on the failure of many Medicaid managed care plans to report instances of potential health care provider fraud.

Some Medicaid Managed Care Plans Made Few or No Referrals of Potential Provider Fraud (OEI-03-22-00410)

Medicaid managed care plans are required to identify and refer potential fraud, waste, or abuse—including provider fraud—to State Medicaid agencies and/or Medicaid Fraud Control Units (MFCUs) for further investigation and enforcement.  One objective of this report was to determine the number of referrals of potential provider fraud, waste, or abuse that plans made to State Medicaid agencies, MFCUs, or other entities in 2022.  Ten percent of surveyed plans reported that they did not make any provider referrals that year.  Of the plans that reported making provider referrals in 2022, more than half made two or fewer referrals per 10,000 enrollees.  HHS OIG: 1) recommends that the Centers for Medicare and Medicaid Services follow up with States that had Medicaid managed care plans with no provider referrals in 2022; and 2) encourages States to increase the number of Medicaid managed care plans that have received State-led training on the fraud referral process.

Read the Full Report