On August 28, 2023, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) published a new “Featured Topic” webpage on managed care oversight. The OIG’s Featured Topics include compilations of the OIG's existing work related to a specific subject matter area and are updated as new material is published.
Due to the growth of managed care and the significant differences between fee-for-service and managed care programs, the OIG has designated oversight of managed care as a priority area and has developed a coordinated plan for managed care oversight (the “Managed Care Strategic Plan”). Effective implementation of the Managed Care Strategic Plan will require the OIG to conduct rigorous oversight of managed care plans during each stage of the managed care life cycle (i.e., plan establishment and contracting, enrollment, payment, and services). To address the risks associated with each stage of the managed care plan life cycle, the OIG has identified three strategic goals: (1) promote access to care for people enrolled in managed care, (2) provide comprehensive financial oversight, and (3) promote data accuracy and encourage data-driven decisions. Under each of these categories, the OIG has specified certain objectives to fight fraud, waste, and abuse.
Managed care plans should consult this Featured Topic to understand potential risk areas and how to address them. The Managed Care Strategic Plan, as well as other OIG managed care resources, can be found on the OIG’s new “Featured Topic” webpage on managed care at https://oig.hhs.gov/reports-and-publications/featured-topics/managed-care/.