Program Integrity in Medicaid

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March 2012

Program integrity in both public and private insurance programs consists of efforts to deter and detect fraud, waste, and abuse and to improve program management, monitoring, and oversight. Chapter 4 of the March 2012 report to Congress discusses anti-fraud and abuse programs and examines key features of program integrity initiatives in Medicaid, including initiatives to deter and detect fraud and abuse at the federal and state levels and assess the interaction of the multiple agencies involved in these efforts.

The chapter contains two recommendations. The first recommendation addresses the importance of improving coordination and removing program redundancies across federal and state program integrity initiatives. The second focuses on improving analytic tools and accelerating and broadening the dissemination of best practices for deterring and detecting fraud and abuse. Read more about program integrity in Medicaid.

Publication Type: Reports to Congress

From: March 2012 Report to the Congress on Medicaid and CHIP

Tags: administration, data, eligibility determination, managed care, oversight, program integrity, waste/fraud/abuse