Oklahoma’s Medicaid payment error rate is one of the lowest in the nation, according to new data published by the Health Care Authority. The state Medicaid agency said in a press release that it is working to maintain this number with new fraud-prevention tools.
The Payment Error Rate Measurement looks at improper payments in Medicaid and the Children’s Health Insurance Program (CHIP) and produces improper payment rates for each program. CHIP provides health coverage to uninsured children in families with incomes too high to qualify for Medicaid, but too low to afford private or group health plans.
States are reviewed every three years. Improper payment rates are based on reviews of fee-for-service, managed care and eligibility components of Medicaid and CHIP in the year under review.
Under fee-for-service, the Health Care Authority pays providers directly for serving aged, blind and disabled Oklahomans. Under managed care, the agency pays private insurance companies to coordinate care for pregnant women, children, and adults covered by Medicaid expansion.
Oklahoma’s improper payment rate for 2025 is .15% for Medicaid and .88% for CHIP, according to the Health Care Authority. The national averages are 6.12% and 7.05%, respectively.
Rebecca Sheppard, an agency spokesperson, said in an email that all processes and methodologies had to be finalized and established before July 1, 2023. Therefore, this review period did not account for the mid-cycle implementation of Oklahoma’s managed care programs.
Auditors reviewed 413 sample claims, which consisted of 288 fee-for-service claims and 125 cases of Medicaid eligibility. One fee-for-service claim was in error.
Oklahoma is projected to have 10.6 million federal dollars in error, according to the U.S. Department of Health and Human Services 2030 Observatory dashboard. Sheppard said the agency cannot verify or guarantee the absolute accuracy of this reporting methodology because it is third-party tracking.
The Health Care Authority said it is working to combat “sophisticated, organized fraud” through new measures implemented during the past three months. This follows Oklahoma Attorney General Gentner Drummond launching an investigation into the agency’s handling of alleged fraud after it uncovered an international crime ring believed to have fraudulently enrolled thousands of Oklahomans in Medicaid.
“Oklahomans expect every taxpayer dollar to be spent the right way, and we hold ourselves to that standard,” Interim Health Care Authority CEO Aaron Morris said in the press release. “We are continuously enhancing our tools to ensure Medicaid dollars are preserved and available to fund services for Oklahomans in need.”
The agency has implemented advanced bot protection in the application process, and geotracking and international IP address blocking, Sheppard said. It is also working with partners like global data, analytics, and technology company Equifax. The goal is to identify fraudulent activity and prevent unauthorized enrollments before claims are processed.
“OHCA’s broader plan to protect program integrity combines strict provider credentialing and revalidations of high-risk providers with targeted post-payment audits that verify medical necessity and proper documentation,” the press release said.
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