Managed Care Sanctions: An Important Tool for Accountability

Executive Summary

This report is part of the National Health Law Program’s ongoing work on accountability in Medicaid managed care, focusing on sanctions, which are one of the tools available to states to hold managed care organizations (MCOs) accountable for failing to meet their obligations. Our research indicates that the states we reviewed use only a fraction of their potential sanctioning powers. They also take different approaches in making their information about sanctions publicly available and the quality of that information is inconsistent from state to state. Lastly, we found that, except in a few cases, the fines imposed on MCOs are minuscule compared to their yearly revenues and profits.

Updated December 20, 2022

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