|Financial Audit Division Report 18-10||Released August 1, 2018|
The Department of Human Services (DHS) is responsible for overseeing Minnesota’s public health care programs, and the department contracts with managed care organizations (MCOs) to provide certain administrative functions and services to program enrollees. For calendar year 2017, eight MCOs reported about $4.8 billion in medical expenses for MinnesotaCare, the Prepaid Medical Assistance Program, and the Special Needs Basic Care program.
The Office of the Legislative Auditor conducted this audit to determine each MCO’s compliance with selected legal and contract requirements to report patient encounter and medical claims data to DHS. Our audit scope focused on a sample of encounter data and payments to medical providers reported by the MCOs for these Minnesota health care programs for calendar year 2017.
For the sample encounter records that we tested, HealthPartners, Hennepin Health, Itasca Medical Care, PrimeWest Health, South Country Health Alliance, and UCare Complied with selected DHS reporting requirements, and the payment information was accurate and complete. Blue Plus and Medica also Generally Complied with these requirements, although we found a small number of exceptions.