2 research outputs found
AHCA making progress but stronger detection, sanctions, and managed care oversight needed (Report No. 08-08)
Since our 2006 review, AHCA has taken steps we recommended to improve performance reporting and to strengthen its ability to safeguard the state against provider waste, abuse, and fraud in the Medicaid program. However, AHCA has not implemented our recommendations to develop a sustainable advanced detection system using artificial intelligence and to strengthen its sanctioning process by establishing fines that represent a minimum percentage of identified overpayments. While AHCA has strengthened its oversight of Medicaid managed care organizations, more steps are needed to deter and detect corporate level abusive and fraudulent practices.Research ReportFinal report publishe
Medicaid Reform: Beneficiaries earn enhanced benefits credits but spend only a small proportion (Report 08-45)
The Medicaid Reform enhanced benefits account program rewards beneficiaries for participating in activities that can improve their health. Beneficiaries can earn credits up to 13.8 million and had redeemed about $1.6 million (11.4%) of this amount for health-related products. Stakeholders are concerned that some Reform beneficiaries are unaware of the program or may find it difficult to redeem earned credits. In addition, the program design may not adequately support long-term change in healthy behaviors. While the Agency for Health Care Administration has taken steps to improve beneficiaries’ awareness, additional operational and program design challenges remain.Research ReportFinal report publishe