Show summary Hide summary
Oklahoma’s attorney general has asked the state auditor to launch an audit of the private firms that manage SoonerCare, citing widespread complaints from providers about delayed payments, claim-processing errors and denials of care. The request, made after what the AG calls insufficient responses from the state Medicaid agency, could prompt renewed scrutiny of how managed care is operating in Oklahoma now.
In a letter to State Auditor and Inspector Cindy Byrd, Attorney General Gentner Drummond said the Oklahoma Health Care Authority has not adequately answered formal inquiries about the contracted managed care organizations. Drummond argues that failing to hold the companies accountable has left providers struggling and some patients without timely access to services.
OHCA, which administers Medicaid in Oklahoma under the program name SoonerCare, responded that it will cooperate with any review. The agency emphasized a commitment to transparency while noting it had already highlighted generally high claim approval rates in a written reply to the AG earlier this month.
SoonerCare audit sought by Oklahoma AG after concerns over for-profit management
OKC Thunder move to Continental Coliseum: what fans need to know
What officials say and why it matters now
Drummond’s move follows months of reports from doctors, clinics and other providers who say payments have been slow, denials are rising and claims are sometimes mishandled. The attorney general told the auditor he repeatedly requested written corrective plans from OHCA leadership but received mostly verbal assurances instead.
For patients, the stakes are concrete: SoonerCare covers services for pregnant women, children, people with disabilities, elderly enrollees and certain cancer patients. Any disruption in claims processing or authorization procedures can delay care or create administrative burdens for families and medical practices.
- Who requested the audit: Attorney General Gentner Drummond asked State Auditor Cindy Byrd to open a review.
- Target of the request: The Oklahoma Health Care Authority’s oversight of contracted managed care organizations (MCOs).
- Allegations: Payment delays, failure to process claims properly and inappropriate denials reported by providers.
- Contracted MCOs: Humana, Aetna and Oklahoma Complete Health — all operate under for-profit models.
- Agency response: OHCA said it will cooperate with any audit and affirmed its commitment to accountability.
Background and recent developments
Oklahoma switched SoonerCare to a managed-care model some years ago. Under that arrangement, private insurers are paid to administer benefits and process claims. Critics say that model can create incentives to limit expenditures, while supporters argue it controls costs and delivers coordinated care.
In late April Drummond issued a public statement pressing for corrective action after documenting what he called systemic problems. He also pointed to a prior intervention in February, when he urged OHCA to abandon a proposed rule requiring preauthorization for certain dental extractions for SoonerCare patients.
A spokesperson for the state auditor’s office said Byrd cannot comment on active or potential audits.
Possible outcomes and next steps
An audit could examine contract compliance, claims-processing timelines, denial reasons and communications between OHCA and the MCOs. Depending on findings, the review might recommend administrative changes, tighter oversight, or contractual remedies to ensure access to care.
State officials, providers and the MCOs will be watching the auditor’s response closely: the process could reshape how SoonerCare is managed and how quickly providers receive reimbursement.
