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Steps for returning fed share and including provider audit OPs in rate setting
Wisconsin OIG is still working with our Medicaid policy partners to try to establish recovery of network provider overpayments. We are trying to establish a finders’ keepers model with OIG recovering from the MCO and the MCO recovering from the network provider. Our partners are having difficulty visualizing how the federal reporting would work for overpayments recovered from the MCO as well as the impact of recovering overpayments from the MCO on the rate setting process. Any additional information that could be provided concerning the appeals processes would be helpful as well.
I am wondering if you could share any process documents you may have outside of your contract language that may help us help our Medicaid partners visualize the operational components of these processes? I am happy to schedule a meeting if you would prefer. Please feel free to contact me directly at kari.engelke@wisconsin.gov.
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