Compliance part of Medicaid HMO regs
Medicaid HMOs are not escaping the federal government's new emphasis on managed care compliance. Proposed HCFA regs that would make it easier for states to place Medicaid beneficiaries in HMOs also contain a requirement for Medicaid HMO compliance. Section 438.606 of the regs, which were published in the Sept. 29 Federal Register, would require any managed care organizations to "have
administrative and management arrangements or procedures designed to guard against fraud and abuse." Any "credible information on violations of the law" by the HMO, its subcontractors and enrollees must be reported to the state, HCFA and OIG. However, HCFA does specify that information on enrollees need only be reported if the violations pertain to enrollment in the health plan, or provision of and payment for services.
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