• Date Due: December 01, 2026
  • Author: Department of Medical Assistance Services
  • Enabling Authority: Appropriation Act - Item 295 YY. (Special Session I, 2026)
  • Description:
    Report on the findings and recommendations of the vendor review and assessment to improve program integrity efforts at the Department of Medical Assistance Services and its contracted managed care organizations (MCOs), including: (i) detection of fraud, waste and abuse including use of data analytics, auditing, and how suspected fraud is reported; (ii) how referrals are made to the Medicaid Fraud Control Unit and the follow-up on such investigations; (iii) enforcement capabilities; and (iv) how DMAS prevents fraud, waste and abuse through training, education, provider credentialing and enrollment, utilization management, and system edits.