100 Days…100 Facts: Preventing Fraud in Managed Care Programs

Preventing Fraud in Managed Care Programs

The federal government is investigating potential fraud claims pertaining to the
state’s biggest health maintenance organizations (HMOs). The state’s Medicaid Program,
also known as the Medical Assistance Program, is being investigated on allegations
that it inflated health care premiums to receive additional matching funds from
the federal government. A bill approved by the Minnesota Legislature with bipartisan
support creates an additional layer of needed oversight for the state’s managed
care programs. It changes managed care financial programming and requires an annual
independent third-party financial audit that will include a determination of compliance
with the federal Medicaid rate certification process.

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