Oklahoma Attorney General Gentner Drummond has called for an independent audit of the Oklahoma Health Care Authority (OHCA), following ongoing complaints about the state’s Medicaid managed care system. In a letter sent on April 24, Drummond formally asked State Auditor Cindy Byrd to investigate a range of issues, including delayed payments, claims processing failures, and the denial of medically necessary care.
Key Issues Cited in the Request
The Attorney General’s letter highlights several concerns raised by healthcare providers and Medicaid recipients:
- Delayed payments to healthcare providers
- Claims processing failures that hinder timely care
- Denials of medically necessary care that have reportedly affected patient outcomes
Drummond’s request focuses on three major Managed Care Organizations (MCOs) contracted by the state: Humana, Aetna, and Oklahoma Complete Health. These organizations are responsible for administering Medicaid services under the state’s managed care system.
Impact on Providers and Patients
Drummond noted that healthcare providers have reported significant operational strain, with some reducing staff as a result of the inefficiencies in the Medicaid system. Additionally, patients are allegedly being denied essential services due to the failings within the managed care process.
The Attorney General criticized the Oklahoma Health Care Authority’s response to these ongoing issues. While OHCA officials provided verbal assurances that the problems would be addressed, Drummond argued that there has been little written action or concrete steps to resolve the situation.
Drummond’s Comments on the Situation
In his letter, Drummond expressed his frustration with the system, stating, “Oklahoma’s second experiment with managed care Medicaid is failing to deliver on its promises.” He further pointed out that out-of-state corporations are controlling access to critical services without proper accountability.
OHCA’s Response
Clay Bullard, CEO of the Oklahoma Health Care Authority, acknowledged the problems in an April 10 response but defended the managed care organizations, highlighting high claim approval rates as evidence of progress.
An OHCA spokesperson responded to Drummond’s request, stating that the agency is committed to transparency and accountability in its operations. The spokesperson also confirmed that OHCA will cooperate fully with the review process initiated by the Attorney General.
Next Steps in the Investigation
The audit request comes at a critical time for Oklahoma’s Medicaid system, as healthcare providers and patients continue to experience significant challenges. The State Auditor’s review will likely play a pivotal role in addressing the systemic issues and determining whether further action is required to restore accountability and ensure the delivery of essential services to those who rely on Medicaid.
