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An Audit Report on The Health and Human Services Commission's Monitoring of Managed Care Contracts

An Audit Report on The Health and Human Services Commission's Monitoring of Managed Care Contracts


November 2003

Report Number 04-011

Overall Conclusion

The Health and Human Services Commission (Commission) has not established adequate systems and controls to monitor its Medicaid and Children's Health Insurance Program (CHIP) managed care contracts. Our audit identified more than $13 million in funds due to the State that the Commission was not actively attempting to collect or recoup from managed care organizations (MCO). (This includes $10.2 million in CHIP experience rebates, $1.7 million in Medicaid experience rebates, and $1.5 million in improper audit fee payments.)

The problems that the Commission has experienced in transferring Medicaid programs and staff from the Department of Health should help to identify potential high risk areas associated with the upcoming consolidation of health and human service agency support and program functions under House Bill 2292 (78th Legislature, Regular Session).

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