To crack down on Medicaid fraud and waste, The Centers for Medicare & Medicaid Services (CMS) will conduct audits of state programs and private Medicaid managed care plans as part of an initiative announced Tuesday, June 26.
CMS administrator Seema Verma attributed these plans to the agency’s reformation of Medicaid for “a focus on integrity and accountability.”
Over $2.1 billion was allocated to the Health Care Fraud and Abuse program in the Program Integrity FY 2018 budget. The total includes both mandatory and discretionary investments.
Fierce Healthcare reported that audit reviews are slated to begin in summer and will include expansion and non-expansion states.
Through the audits, CMS will be able to determine if states are receiving proper funds and matching Medicaid compensation. A Government Accountability Office report in April found $37 billion in improper Medicaid payments for the last year alone–including fraud.
All states are now also reporting data to the Transformed Medicaid Statistical Information System (T-MSIS) database, where CMS can see Medicaid spending down down to the individual. This is another measure taken to identify and hopefully prevent Medicaid waste and fraud.
Seema Verma said in a statement,
“We have a responsibility to ensure that taxpayer dollars are only spent on those who are eligible.”
Read more about CMS’ plans at Fierce Healthcare.