6 Criteria for Choosing a State’s Managed Care Compliance Provider

When it comes to providing oversight of managed care expenditures and performance at the state level, your choice of an outside auditing firm is crucial. With numerous options available, identifying the right finalists can be a bit overwhelming. While firms may vary in size, capabilities and specific strengths, there are six key criteria you should consider when selecting a provider.

  1. Areas of Expertise

Conducting any audit or compliance engagement requires a specific set of skills. But in addition to these, the oversight of state Medicaid or Medicare managed care expenditures calls for proven competence in two very important areas. First, they should have a thorough familiarity with the workings, realities and expectations of government agencies. Second, they should have a keen understanding of healthcare, both on the payor and provider side.  The firm’s ability to leverage subject matter experts to see beyond the current state of managed care programs is vital. Situational awareness of the broad environment is critical to delivering high-quality solutions.

  1. Reputation

For many firms, the ability to consistently execute engagements on time, on budget and to expectation is not a core strength. Before you reach a decision, research the firm’s reputation in the industry – both as a service provider and as an employer. Look for client testimonials, case studies and online reviews to gauge their credibility and reliability. And above all, ask for references – preferably from recent engagements of similar scope and nature. Positive reviews and strong references indicate that the firm knows how to deliver quality service and maintain strong client relationships. The proven integrity and system of quality control of a firm matters.

  1. Range of Services

During an engagement, your firm may encounter a situation that calls for additional resources or expertise. Or, they may see conditions that could be improved if the right technology or processes were in place.

It’s important to enlist a firm that can handle all aspects of auditing and compliance, including financial audits, internal controls, risk assessments and regulatory compliance. But beyond that, look for a firm that provides a wide range of services to ensure that all your needs are met under one roof, and that any IT, process or procedural improvements can be addressed, if they arise, as well as the ability to assess and respond to risks that may not be easily visible on the surface of an engagement.

  1. Technology and Resources

In today’s digital landscape, it is crucial for auditing and compliance firms to be able to leverage advanced technology and solutions. Ask about the firm’s technological capabilities, the software they use for audits and their abilities in areas like data management and analytics. A firm that utilizes cutting-edge technology can streamline processes, improve efficiencies and provide you with more reliable insights and reporting.

  1. Pricing and Value

In working with accounting, auditing and consulting firms, it’s not uncommon to find a broad array of rates for somewhat comparable capabilities. Carefully evaluate the pricing structure and value provided by your auditing and compliance firm.

While you should never “race to the bottom” and let price be the determining factor in your decision, you should at minimum expect transparency in pricing, and a rate structure that represents a good overall value for the capabilities being offered. In comparing value, be sure to consider the expertise and experience of the specific staff members who will be heading the engagement.

  1. The People

Last but not least, find out exactly who you will be working with. Any firm can cite past assignments and case studies. But were the people assigned to your account directly involved? Before deciding, be sure to meet the primary stakeholders who will be overseeing your engagement, as well as the team members that you will be communicating with day to day. Firms can boast of size, experience and capabilities. But in the end, it will be your specific team that determines the success of your engagement.


HORNE is a professional services firm founded on the cornerstone of public accounting. As a Top 25 Accounting Firm, our CPA heritage brings trust and discipline to our brand and with over 60 years of dedication to serving the healthcare industry, HORNE brings to the table unparalleled resources with the depth and breadth of understanding the managed care environment from multiple lenses including provider, payer and state oversight. In working with both urban and rural healthcare organizations as well as state agencies across the US and Puerto Rico, our Healthcare team has accumulated a working knowledge of the concerns and challenges that this industry faces. HORNE has earned the reputation as a partner trusted to deliver with complex needs.

To find out more about the services we offer, contact us today.



More Insights

Demystifying OSHA Inspections and Enhancing Workplace Safety

Are you confident that your team is prepared for an OSHA site visit? If the answer is no, or if you want to be more prepared, then join us as we...


Market Dislocations: Bid-Ask Spread and Risk Premium in Healthcare

We have been hearing about a “bid-ask spread” issue in the lower middle market healthcare space for a significant time, and I wanted to discuss...


HORNE’s Board of Directors Announces New CFO

HORNE’s Board of Directors recently appointed Kennon Breaux as the firm’s chief financial...


HORNE Board of Directors Announces New Director of AI and Innovation

HORNE’s Board of Directors recently appointed Naveen Khan as the director of AI and Innovation for HORNE’s Intelligence and Automation...


Section 3 in HUD Programs

If you represent a HUD organization that regularly receives Federal funds, you are probably familiar with requirements relating to Federal Labor...


Compliance with Federal Environmental Review Requirements

Did you know that every Federally-funded project must undergo an environmental review before any funds can be spent, or even committed to a project?...


Talk to an expert today.