Comprehensive Health Care Program – Oversight and Encounter Claim Integrity - 391-0702-17

Description of Agency

The Comprehensive Health Care Program was initiated as the 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 care management services to the Medicaid population.

During fiscal years 2015 and 2016, total capitated rate payments were approximately $7.4 and $8.0 billion dollars, respectively. As of May 1, 2017, there were approximately 1.8 million individuals enrolled in managed care through either the Medicaid or Healthy Michigan programs.

Audit Objectives

  1. To evaluate the sufficiency of MDHHS’s oversight efforts to ensure MHP-enrolled beneficiary access to medical care.

  2. To assess the sufficiency of MDHHS’s efforts to ensure that MHPs’ encounter claim data met selected Medicaid program criteria.

  3. To assess the sufficiency of MDHHS’s efforts to monitor the MHPs’ provider networks.


Estimated Release Date: April 2019

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