Health and Human Services
A Follow-Up Audit of Medicaid Managed Care at the Department of Health
August 2000
Report Number 00-039
Overall Conclusion
Since February 1998, the Department of Health (Department) has improved its oversight of the Medicaid managed care program.
Key Facts and Findings
The Department has implemented adequate controls over both contract administration with health maintenance organizations (HMOs) and the reporting of encounter data, which is the record of services provided to patients.
The Department should ensure that HMOs continue to improve the accuracy and completeness of the encounter data. The Public Policy Research Institute at Texas A&M University noted in January 2000 that "obtaining reliable and accurate encounter data remains a significant obstacle to measuring quality [of] and access [to]" the managed care program.
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