On August 28, 2023, OIG released a strategic plan outlining the current risks of fraud, waste, and abuse in Medicare and Medicaid managed care programs and establishing OIG’s goals to help address those risks. According to the plan, 50% of Medicare enrollees received coverage through Medicare Advantage plans in 2022, accounting for $403 billion–or 50%--of government spending on Medicare. Likewise, 81% of current Medicaid enrollees received some component of their coverage through managed care. The strategic plan recognizes this significant government commitment to managed care and reinforces OIG’s efforts to prioritize effective oversight.
The three key goals for OIG are: (1) promoting access to care for managed care enrollees, (2) providing financial oversight, and (3) promoting data accuracy and data-driven decisions. Within each of these goals, OIG identified objectives the watchdog intends to use to ensure progress is made towards accomplishing each goal. As part of the plan, OIG also developed a managed care lifecycle tool to provide a framework for its oversight work. The tool establishes four phases of managed care: plan establishment and contracting, enrollment, payment, and services to people. Pursuant to the plan, OIG intends to tailor oversight and enforcement activities to each of these phases individually to fully address its goals across the lifecycle of managed care.
For more information and a summary of the plan, visit OIG’s managed care website.