Oversight and Encounter Claim Integrity of the Comprehensive Health Care Program - 391-0702-17F

Description of Program

The Comprehensive Health Care Program was initiated as a mechanism for controlling costs and improving beneficiary care in Michigan’s Medicaid program. The Michigan Department of Health and Human Services (MDHHS) contracts with Medicaid Health Plans (MHPs) to provide health care and management services to the Medicaid and Healthy Michigan Plan (HMP) beneficiaries who chose or are required to be enrolled in an MHP. From June 1, 2021 through May 31, 2022, MDHHS’s capitated rate payments totaled $7.6 billion for a monthly average of 2.2 million Medicaid and HMP beneficiaries. For this same period, MHPs submitted approximately 81.9 million encounter claims (as of June 8, 2022) representing medical services provided to MHP-enrolled beneficiaries.

Audit Objectives

  • The audit is currently in planning and the audit objectives are not yet finalized.

Timing

Estimated Release Date: Late 2022


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