Oklahoma Health Care Authority (Medicaid) · October 24, 2026 · Primary source
OHCA Builds on National-Leading Medicaid Accuracy with New Tools to Prevent Fraud and Increase Transparency
Summary
The Oklahoma Health Care Authority (OHCA) announced a set of new program integrity tools targeting Medicaid fraud, waste, and abuse, citing a 0.15 percent improper payment rate under the federal PERM audit cycle, well below the 6.12 percent national average. New controls include advanced network traffic assessment, firewall-based bot detection, automated application screening, and dynamic data validation through Equifax to block fraudulent enrollments. OHCA is also partnering with SoonerSelect managed care plans on pre-payment analytics to detect copy-pasted clinical notes and other billing anomalies. A new public-facing "Care with Accountability" webpage allows Oklahomans to view program integrity activities and report suspected fraud.
What this may mean
OHCA's expanded fraud controls add pre-payment claim review, post-payment audit targeting, and enhanced provider credentialing and revalidation requirements for high-risk providers. SoonerSelect managed care plans are now integrated into pre-payment analytics, making plan-level billing review a formal program integrity function. Providers billing SoonerCare face heightened scrutiny for documentation integrity, particularly around individualized clinical notes.
Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.
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