Audit: GA Medicaid oversight is uncoordinated, risks overpaying, fraud

Georgia’s faulty oversight of private Medicaid management contractors has left the state’s Medicaid program vulnerable to overpaying for health care and to fraud, a state auditor’s report has found.

Over seven years from 2013 to 2019, a total of $41 million in claims the contractors paid out for Medicaid “were not subject to adequate oversight and claims review,” the report says, and some questionable claims were forwarded to the state for review but left to languish for years.

Scattered oversight systems that lack coordination are at fault, the report says.

[…] The need to reduce silos and improve coordination “is a common concern” across many Georgia agencies, said Laura Harker, senior health policy analyst at the Georgia Budget and Policy Institute. “The managed care organizations take a lot of credit for reducing state Medicaid costs,” she said. “But just because they help produce savings doesn’t mean they don’t need oversight on ensuring they are making the correct payments.”

Read full article at Atlanta Journal-Constitution.

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