HB3358 creates a detailed statutory framework for Oklahoma Medicaid provider and managed care organization audits, overpayment determinations, and fraud-related enforcement. It defines key terms such as claim, clean claim, overpayment, credible allegation of fraud, Medicaid provider, managed care organization, and subcontractor, and gives the Oklahoma Health Care Authority (OHCA) authority to review records, inspect personnel and subcontractor records, and investigate possible contract breaches, deceptive marketing, or fraudulent procurement of Medicaid benefits.
The bill also establishes record-retention and production requirements. Medicaid providers, managed care organizations, and subcontractors would have to keep relevant medical and business records for at least six years and produce them quickly upon request, generally within two business days, or ten business days for records held off-site by subcontractors or satellite offices. Failure to comply would be a statutory violation, and OHCA would be directed to adopt rules to administer and enforce the new provisions.
A major portion of the bill governs audits and overpayment disputes. OHCA could audit providers using sampling, but extrapolation of audit findings would be limited unless the error rate exceeds 10 percent and the sample is statistically valid. Before issuing a final overpayment determination or finding a credible allegation of fraud, OHCA must provide a written preliminary finding, identify the factual and legal basis, and allow an informal conference. Providers may also submit corrective action plans to address clerical, typographical, scrivener’s, computer, credentialing, licensure, or training issues. If a final overpayment determination is issued, the provider may request an expedited adjudicatory proceeding, with specified timelines, hearing-officer qualifications, and the ability to challenge the audit methodology, the credentials of auditors, and the agency’s determination in district court if the contract allows.
The bill’s impact on state law would be to add new Medicaid audit and appeals procedures to Title 63, giving OHCA clearer enforcement tools while also creating procedural protections for providers and managed care organizations. It would codify audit standards, recordkeeping duties, dispute-resolution steps, and hearing requirements, and it would make the new framework effective November 1, 2026.
The general sentiment reflected by the bill text is balanced but enforcement-oriented: it appears designed to tighten oversight of Medicaid billing and contract compliance while preserving due process for providers. No committee transcripts or recorded votes were provided, so there is no direct evidence of support or opposition from debate or roll call history. The main points of contention likely concern the breadth of OHCA’s audit authority, the short deadlines for producing records and responding to findings, limits on extrapolation, and the extent of provider rights to challenge audits and overpayment determinations.
HB3358 would amend Oklahoma law by creating new sections in Title 63 governing Medicaid provider and managed care organization audits, record retention, overpayment findings, fraud allegations, corrective action plans, and expedited administrative appeals. It expands OHCA’s oversight authority while also imposing procedural requirements on the agency and compliance obligations on providers, subcontractors, and managed care organizations.
No committee discussion or vote history was provided, so sentiment must be inferred from the bill text alone. The bill appears to reflect a policy compromise: it strengthens OHCA’s ability to investigate and recover overpayments, but it also adds notice, conference, corrective-action, and appeal rights for providers. Overall, the measure reads as pro-enforcement with built-in due process protections rather than strongly punitive or deregulatory.
Likely areas of contention include the six-year record-retention requirement, the two-day and ten-day deadlines for producing records, the authority to impose penalties and suspend or revoke contracts, and the limits on audit extrapolation unless the error rate exceeds 10 percent. Providers and managed care organizations may favor the appeal rights, corrective action plans, and restrictions on extrapolation, while OHCA and fraud-control advocates may view those same provisions as potentially limiting recovery efforts. The bill also creates potential debate over who qualifies as an independent auditor or hearing officer and how much discretion OHCA should have in resolving disputes.