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Health-Care-Acquired Conditions - Medicaid Managed Care Organizations

Previous OIG reviews found that some States continued to make Fee-for-Service Medicaid payments for hospital care associated with health-care-acquired conditions and provider preventable conditions. Provider preventable conditions are certain reasonably preventable conditions caused by medical accidents or errors in the health care setting. The Patient Protection and Affordable Care Act, § 2702, and implementing regulations at 42 CFR, § 447.26, prohibit Federal payments for provider preventable conditions. Because we found problems with States making fee-for-service payments associated with provider preventable conditions, we are expanding to managed care arrangements. We will also determine whether Medicaid managed care organizations (MCOs) have continued to make payments to providers for inpatient hospital services related to treating certain provider preventable conditions.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Nov-16 Centers for Medicare & Medicaid Services Health-Care-Acquired Conditions - Medicaid Managed Care Organizations Office of Audit Services W-00-17-31519; various reviews 2019