On Thursday, Oklahoma Health Care Authority board voted to approve spending money to hire a recovery audit contractor.
This contractor, which will be hired through competitive bidding, will audit Medicaid claims and look for overpayments and underpayments. The contractor will also try to recoup this money when possible.
The Oklahoma Health Care Authority is in charge of Oklahoma's Medicaid program known as SoonerCare. The authority has a program integrity unit that already audits the money that medical professionals receive for the services they provide Medicaid patients.
However, federal regulation requires the authority to hire a recovery audit contractor.
Mike Fogarty, the health care authority CEO, said he thought the board should approve the action, even though he thought it was a waste of federal money for a recovery audit contractor to provide this service in Oklahoma.
“When you take a state like Oklahoma that has an error rate of under 2 percent, (the federal government) probably could better spend their resources somewhere that's closer to the average Medicaid error rate of 8 percent or 9 percent, and not paint all states with this broad brush,” Fogarty said.
Fogarty said he was concerned that Medicaid providers in Oklahoma will have mostly negative experiences with the recovery audit contractor.
“They're going to have people unknown to them that are on a contingency basis auditing them, and they will know going in that it's an entity that's only going to make money if they find something wrong,” Fogarty said.
Fogarty said he hoped that the authority could write its contract with the recovery audit group in such a way that might curb some of these potential negative side effects that the Medicaid providers might experience.
In other action
Other meeting actions included:
• The board voted to increase about 90 reimbursement rates related to Medicaid developmental disability services; Medicaid Advantage home and community-based waiver services; and the Oklahoma Health Care Authority Living Choice services.
• The board went into executive session to discuss hiring a CEO but did not take action.