mediFraudPublic health care programs may soon see a greater number of audits as the Centers for Medicare & Medicaid Services (CMS) seek to combat improper payments and Medicaid fraud. With Medicaid spending reaching more than half a billion in 2016, CMS has made the decision to reinforce the relationship between states and the federal government in order to better ensure the Medicaid program’s integrity. Besides audits, CMS also has plans to better oversee any contracts between private insurance companies and states as well as beneficiary eligibility. The agency also intends to strictly enforce the federal rules and making sure states are maintaining compliance.

There is a trio of initiatives CMS is concentrating on to prevent fraud involving Medicare and improper payments. The first of these involves state claim audits for medical loss ratios and federal match funds. The second will focus on conducting audits for determining state beneficiary eligibility. The third includes plans to boost provider and claims data sent in by states.

CMS reported that each state including Washington DC and Puerto Rico is now sending in all-encompassing data to CMS. As a result of this milestone, the federal agency wishes to validate the quality and completeness of the data to make improvements to Medicaid eligibility and payment information.

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