Menu Close

CMS Announces Initiatives to Reduce Medicaid Fraud, Waste

Posted in Electronic Health Records, Fraud and Abuse, Legislation and Public Policy, Medical Loss Ratio, Medicare and Medicaid, Reimbursement Matters, State Matters

On June 26, the Centers for Medicare & Medicaid Services (CMS) announced numerous initiatives to reduce fraud and waste in the Medicaid program. CMS Administrator Seema Verma discussed the new efforts at a briefing with reporters, and they are described in a CMS Medicaid Program Integrity Strategy fact sheet.CMS plans to audit state Medicaid beneficiary eligibility determinations to confirm that beneficiaries are enrolled in the correct eligibility tiers and that states are reporting expenses accurately. CMS will also audit private Medicaid managed care plans to ensure that the costs they report match the amounts actually spent.

Among the other new initiatives, CMS plans to improve its data sharing with states through the Transformed Medicaid Statistical Information System (TMSIS) database, which will allow CMS to monitor Medicaid spending on individual beneficiaries, and to centralize the screening of healthcare providers for Medicaid enrollment to simplify the process for states.

Leave a Reply

Your email address will not be published. Required fields are marked *