Medicaid provider audits; terms; review of Medicaid providers or managed care organizations; penalties; retain records; production of records; promulgation of rules; determination of overpayments; credible allegations of fraud; methodology for audits; notice; informal conference; expedited adjudicatory proceeding; Oklahoma Health Care Authority; corrective action plans; qualifications for hearing officer; costs; preliminary or final determination for overpayment; effective date.

2026 Regular Session Introduced by Danny Williams

Oklahoma legislation establishing formal Medicaid provider audit procedures, overpayment recovery processes, and fraud investigation protocols with due process protections for audited entities.

Second Reading referred to Rules

Legislative bill overview

HB 3358 establishes a comprehensive framework for auditing Medicaid providers and managed care organizations in Oklahoma, including procedures for identifying overpayments, investigating fraud allegations, and imposing penalties. The bill outlines due process protections for audited entities, including rights to informal conferences and expedited hearings, while requiring the Oklahoma Health Care Authority to develop detailed audit methodologies and rules.

Why is this important

Medicaid fraud and overpayments cost states hundreds of millions annually, directly reducing resources available for patient care. This bill attempts to balance fraud prevention and fiscal accountability with provider protections, clarifying audit procedures that have likely operated under less formal guidance. The due process requirements could significantly impact how quickly the state recovers overpayments while protecting providers from arbitrary enforcement.

Potential points of contention

Audit burden and compliance costs: Expanded audit authority and record-retention requirements may impose substantial administrative costs on smaller healthcare providers, potentially pushing marginal providers out of the system

Speed vs. fairness trade-off: Expedited adjudicatory proceedings aim for quick resolution but may disadvantage providers with limited legal resources compared to the state's compliance infrastructure

Overpayment determination methodology: The bill requires rules to be established for audit methodology, but doesn't specify whether retroactive application will be permitted or how disputed calculation methods will be resolved

Penalty structure ambiguity: The bill mentions penalties without clearly defining them upfront, potentially creating uncertainty about enforcement severity and creating room for regulatory discretion