Audit recommends MCO reporting improvements

An OIG audit of a Texas managed care organization (MCO) evaluated the effectiveness of its special investigative unit (SIU).

MCOs are required to establish an SIU to investigate claims of fraud, waste and abuse by members and service providers.

Effective SIU functions are essential to support overall MCO cost containment efforts, and to ensure that state and federal funds spent on managed care are used appropriately. Read the OIG’s recommendations to prevent fraud, waste and abuse. https://oig.hhsc.texas.gov/sites/default/files/documents/reports/siu-audit-molina-5-22-20.pdf