Oklahoma Attorney General Gentner Drummond has requested an independent audit of the Oklahoma Health Care Authority, citing mounting complaints from providers and what he described as repeated failures by the agency to respond to formal inquiries.
In a letter dated April 24 to State Auditor and Inspector Cindy Byrd, Drummond outlined concerns about the state’s Medicaid managed care system and the agency’s oversight of contracted managed care organizations.
The request follows what Drummond described as a pattern of payment delays, claims processing failures and denials of medically necessary services tied to the state’s managed care program, which is administered by Humana, Aetna and Oklahoma Complete Health.
“Oklahoma’s second experiment with managed care Medicaid is failing to deliver on its promises. Providers are reducing staff. Patients are being denied essential care. Out-of-state corporations are controlling access to critical services without accountability...” Drummond wrote.
According to the letter, providers across Oklahoma have reported ongoing issues, including administrative barriers to claims processing and inconsistent reimbursement determinations.
Drummond also said the Oklahoma Health Care Authority has not provided substantive written responses to multiple formal inquiries from his office over several months, instead offering verbal assurances. In an April 10 response, the agency defended the managed care organizations and cited high claim approval rates while acknowledging that “issues need to be fixed.”
The attorney general said his office had previously demanded corrective action from OHCA Chief Executive Officer Clay Bullard on three occasions.
“When an agency entrusted with Oklahoma’s most vulnerable citizens refuses to hold billion-dollar corporations accountable, it falls to this office to act,” Drummond said. “Providers across this state have been sounding the alarm for months. Oklahoma patients are being denied care they are legally entitled to, and OHCA has chosen to defend the MCOs rather than the people it serves. An independent audit is not only warranted – it is essential to restore accountability and protect public funds.”
In the audit request, Drummond asked the state auditor’s office to examine several areas, including whether managed care organizations are meeting contractual obligations, whether OHCA has implemented adequate oversight and accountability measures, and whether claims practices have resulted in inappropriate denials of medically necessary services.
The letter also calls for a review of public fund stewardship, provider participation — particularly in rural areas — and the administration of provider incentive payments.
Drummond said the audit is necessary to determine whether the agency is fulfilling its responsibilities and to ensure accountability in the state’s Medicaid system.
