Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS)

Medicaid Managed Care: CMS’s Accuracy Check Process For State-Submitted Medical Loss Ratio Data Has Limitations (OEI-03-23-00040)

A medical loss ratio (MLR) shows whether a managed care plan spent most of its Medicaid funds on medical costs.  This review assesses how the Centers for Medicare & Medicaid Services (CMS) verifies the accuracy of MLR data that states submit to CMS.  We found limitations in CMS’s process to check the accuracy of the MLR data, and its completed checks indicated some potential inaccuracies.

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