Review of Program Integrity Operations At Six Managed Care Organizations Delivering Medicaid Services under a Contract with the South Carolina Department of Health & Human Services

The State contracted with six managed care organizations to deliver Medicaid managed care at an annual cost of $2.7 billion, representing 10% of the State’s annual budget, to 750,000 Medicaid beneficiaries in South Carolina. This review’s scope and objectives were: Test the six MCOs’ compliance and effective execution of the SCDHHS’s managed care contract “Section 11 - Program Integrity” focusing on the operational components of pre-payment review and post-payment review. Identify opportunities to improve SCDHHS’s biennial managed care contract, contract monitoring, and MCO compliance and effective execution of the contract.

An Analysis of the Early Prediction of Highway Construction Project Completion using the Contract Status Report

History has shown that projects move in and out of poor status through the life of the project. Predicting the success or failure of a project to complete on time because of its recent history on the contract status report could provide our project managers another tool for monitoring contract progress. In many instances, poor contract progress results in the loss of contract time and late completion of projects. This research evaluates the combinations of work type, point in time physical work begins, recent poor status, and contract bid amount as indicators of late project completion.

Allegation of a Violation of the State Procurement Code and Other Issues Related to a Statewide Term Contract Involving the Department of Revenue and the Department of Health and Environmental Control

A complainant alleged the Department of Revenue violated the South Carolina Procurement Code. This paper examines that complaint.