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Question of the Week -- Will New CMS Initiatives Help Curb Fraud and Waste in Medicaid?

Posted  June 27, 2018

On June 26, 2018 CMS Administrator Seema Verma announced new initiatives to reduce fraud in the Medicaid program. The three new initiatives are to (1) emphasize program integrity in audits of state claims for federal match funds and medical loss ratios (MLRs); (2) conduct new audits of state beneficiary eligibility determinations; and (3) optimize state-provided claims and provider data. These initiatives are meant to curb fraud in Medicaid that topped $37 billion last year according to an April 2018 report from the GAO.

Recent years have seen an increase in the federal share of Medicaid spending due in part to the Medicaid expansion in the Affordable Care Act in which many states have chosen to participate. The federal share of Medicaid spending grew from $263 billion to $363 between 2013 and 2016. Overall spending on Medicaid increased from $456 billion to $576 billion in that same time period.

What do you think? Will the new CMS initiatives help curb fraud and waste in Medicaid?

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Tagged in: Healthcare Fraud, Medicaid, Question of the Week,

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