OHCA builds on national-leading Medicaid accuracy with new tools to prevent fraud and increase transparency

The Oklahoma Health Care Authority (OHCA) is strengthening its protections against Medicaid fraud, waste and abuse, even as Oklahoma leads the nation in Medicaid accuracy and fiscal integrity.

"Oklahomans expect every taxpayer dollar to be spent the right way, and we hold ourselves to that standard," said Interim OHCA CEO Aaron Morris.

"We are continuously enhancing our tools to ensure Medicaid dollars are preserved and available to fund services for Oklahomans in need." That track record shows in the most recent Payment Error Rate Measurement (PERM) results. Oklahoma's improper payment rate is 0.15 percent for Medicaid and 0.88 percent for the Children's Health Insurance Program (CHIP), compared with national averages of 6.12 percent and 7.05 percent. PERM reviews are conducted every three years, and Oklahoma was among the states with the lowest rates in both 2022 and 2025.

To build on that momentum, OHCA is continually adapting its strategy to combat sophisticated, organized fraud, including recent attempts by overseas criminal networks.

The agency now stops unauthorized access at the point of entry through advanced network traffic assessment and firewall controls that detect malicious bots and block suspicious account creation attempts.

These protections, combined with automated application screening and dynamic data validation exchanges with industry partners like Equifax, help 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 agency also partners with SoonerSelect managed care plans on advanced pre-payment analytics, such as detecting copy-pasted clinical notes across multiple patient records.

These tools stop improper billing before payouts occur, so payments go to providers delivering individualized, high-quality care.

OHCA is also opening program integrity work to public view through "Care with Accountability," a new webpage that shows how the agency safeguards taxpayer dollars through provider credential verification, claims monitoring and revalidation of highrisk providers and lets Oklahomans report suspicious activity directly.

Oklahomans can learn more and report suspected fraud, waste or abuse at oklahoma.gov/ohca/fraud.

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