The OIG reviewed waste prevention activities used by managed care organizations (MCOs) as well as the resources used by the OIG to combat fraud, waste and abuse (FWA) in Medicaid managed care.
The OIG surveyed and collaborated with all 20 MCOs and Dental Maintenance Organizations (DMOs) on their use of cost avoidance and waste prevention activities to promote program integrity in Medicaid and CHIP services delivery.
In this review, the OIG found that MCOs implement a variety of cost avoidance measures, including:
- Prepayment review strategies
- Post-payment review strategies
- Strategies related to reducing potentially preventable events.
The OIG also reviewed its resources and findings of incidences of FWA in Medicaid managed care. The OIG found that it dedicates half of its resources directly or indirectly to Medicaid managed care.