Fraud, waste, and abuse (FWA) in Medicaid diverts program funds from their intended purpose, affecting both spending and beneficiary care. It encompasses acts of intentional deception (fraud), exploitation of care or payment systems (abuse), and unnecessary use of health care resources (waste). FWA occurs in both privately funded health care and government-funded health care programs such as Medicare and Medicaid.
Program integrity refers to the activities undertaken to prevent FWA and ensure that federal and state taxpayer dollars are spent appropriately on delivering quality, necessary care. Although program integrity was not an original feature of the Medicaid program, legislation has added safeguards to protect it from FWA.
MACPAC resources on program integrity in Medicaid:
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- Report: Provider Enrollment and Credentialing in Medicaid (2026)
- Comment Letter: Medicaid Program Integrity (2026)
- Issue brief: Program Integrity (2026)
- Testimony: Improper Payments and Ensuring Program Integrity (2024)
- Report: Improving the Effectiveness of Medicaid Program Integrity (2019)
- Report: Program Integrity in Medicaid Managed Care (2017)
- Testimony: Strengthening Medicaid Program Integrity and Closing Program Loopholes (2015)
- Report: Update on Program Integrity in Medicaid (2013)
- Report: Program Integrity in Medicaid (2012)