On August 28, 2023, the U.S. Division of Well being and Human Providers Workplace of Inspector Common (“OIG”) printed a brand new “Featured Matter” webpage on managed care oversight. The OIG’s Featured Subjects embrace compilations of the OIG’s present work associated to a selected material space and are up to date as new materials is printed.
As a result of development of managed care and the numerous variations between fee-for-service and managed care packages, the OIG has designated oversight of managed care as a precedence space and has developed a coordinated plan for managed care oversight (the “Managed Care Strategic Plan”). Efficient implementation of the Managed Care Strategic Plan would require the OIG to conduct rigorous oversight of managed care plans throughout every stage of the managed care life cycle (i.e., plan institution and contracting, enrollment, cost, and providers). To deal with the dangers related to every stage of the managed care plan life cycle, the OIG has recognized three strategic targets: (1) promote entry to look after folks enrolled in managed care, (2) present complete monetary oversight, and (3) promote knowledge accuracy and encourage data-driven selections. Beneath every of those classes, the OIG has specified sure goals to struggle fraud, waste, and abuse.
Managed care plans ought to seek the advice of this Featured Matter to know potential threat areas and how one can handle them. The Managed Care Strategic Plan, in addition to different OIG managed care sources, could be discovered on the OIG’s new “Featured Matter” webpage on managed care at https://oig.hhs.gov/reports-and-publications/featured-topics/managed-care/.
