CMS Announces New Medicaid Program Integrity Initiatives

The Centers for Medicare & Medicaid Services today announced several new Medicaid program integrity initiatives. Specifically, the agency will begin auditing select states based on the amount spent on clinical services and quality improvement versus administration and profit, including looking at managed care state rate setting and health plan medical loss ratios. In addition, the agency will focus on states at “high-risk" for errors in making Medicaid and Children’s Health Insurance Program eligibility determinations; and on validating the quality and completeness of state-provided claims and provider data. “With historic growth in Medicaid comes an urgent federal responsibility to ensure sound fiscal stewardship and oversight of the program,” said CMS Administrator Seema Verma. “These initiatives are the vital steps necessary to respond to Medicaid’s evolving landscape and fulfill our responsibility to beneficiaries and taxpayers.”