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Friday, September 29, 2023

OIG Publishes New “Featured Subject” on Managed Care Oversight


On August 28, 2023, the U.S. Division of Well being and Human Providers Workplace of Inspector Normal (“OIG”) revealed a brand new “Featured Subject” webpage on managed care oversight. The OIG’s Featured Matters embrace compilations of the OIG’s present work associated to a particular material space and are up to date as new materials is revealed.

Because of the progress 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 handle the dangers related to every stage of the managed care plan life cycle, the OIG has recognized three strategic objectives: (1) promote entry to take care of folks enrolled in managed care, (2) present complete monetary oversight, and (3) promote information accuracy and encourage data-driven selections. Below every of those classes, the OIG has specified sure aims to battle fraud, waste, and abuse.

Managed care plans ought to seek the advice of this Featured Subject to grasp potential danger areas and methods to tackle them.  The Managed Care Strategic Plan, in addition to different OIG managed care sources, will be discovered on the OIG’s new “Featured Subject” webpage on managed care at https://oig.hhs.gov/reports-and-publications/featured-topics/managed-care/.

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