Oklahoma Medicaid Audit Requested Amid Provider Complaints

Oklahoma Attorney General Gentner Drummond has requested a state audit of the Oklahoma Health Care Authority (OHCA) following mounting complaints from healthcare providers regarding issues with the state’s Medicaid managed care program, known as SoonerSelect. The audit, requested from State Auditor and Inspector Cindy Byrd, aims to investigate alleged failures in oversight of contracted managed care organizations (MCOs).

Background: Transition to Managed Care

In 2023, Oklahoma transitioned from a fee-for-service Medicaid model to a privatized, managed care system. This shift involved contracting with private companies – Humana, Aetna, and Oklahoma Complete Health – to coordinate care for some Medicaid enrollees. The stated goals of the transition were to reduce costs and improve the quality of care.

Attorney General’s Concerns

According to a letter dated April 24, Drummond’s office has identified a pattern of problems, including payment delays, claims processing failures, and inappropriate denials of medically necessary services. Drummond has repeatedly sought corrective action from OHCA Chief Executive Officer Clay Bullard, but his office reports receiving only verbal assurances and, on April 10, a defense of the MCOs based on claim approval rates, despite acknowledging “issues need to be fixed.”

“Oklahoma’s second experiment with managed care Medicaid is failing to deliver on its promises. Providers are reducing staff. Patients are being denied essential care. Out-of-state corporations are controlling access to critical services without accountability…”

Provider Concerns

Healthcare providers across the state have reported difficulties with the managed care system, including payment delays, barriers to claims processing, and inconsistent reimbursement rates. The Oklahoma State Medical Association has voiced its support for the audit, noting that prior to the implementation of managed care, Oklahoma had some of the lowest Medicaid administrative costs in the nation – at 4% – and physicians were paid promptly.

OHCA Response

Rebecca Sheppard, an OHCA spokesperson, stated that the agency is committed to transparency and accountability and will fully cooperate with the audit process.

Looking Ahead

The requested audit is expected to provide a comprehensive review of the OHCA’s oversight of the managed care organizations and identify areas for improvement. The outcome of the audit could lead to significant changes in how Medicaid is administered in Oklahoma, potentially impacting both healthcare providers and the patients they serve.