Medicaid waste fraud and abuse

The Curious Case of Improper Medicaid Payments

While the Centers for Medicare & Medicaid Services continues its efforts to “crush” Medicaid fraud, a new report says that the biggest source of improper Medicaid payments is… Flawed paperwork. While improper payments generally are categorized as fraud, waste, and abuse, CMS’s focus has been squarely on fraud. At the same time, however, the Congressional Research Service recently reported that flawed paperwork, and not necessarily an attempt to inappropriately or illegally profit from Medicaid payments, is most of the problem. According to the report, CMS estimates that most improper payments (77% in FY2025) are the result of insufficient documentation (e.g., [...]

joe2026-10-14T11:32:26-04:00October 15, 2026|Medicaid|

Federal Health Policy Update for February 26

The following is the latest health policy news from the federal government for February 20-26. Some of the language used below is taken directly from government documents. Congress Both chambers of Congress are in session this week and next. The partial shutdown of the Department of Homeland Security that began on February 23 continues. The House Ways and Means Committee held a hearing titled “Advancing the Next Generation of America’s Health Care Workforce” to examine the shortage of resident physicians and explore ways to strengthen rural health care providers and Graduate Medical Education (GME). Watch the hearing and review the witness testimony here. Centers for Medicare & [...]

joe2026-02-26T15:43:01-05:00February 26, 2026|340b, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

CMS Outlines New Medicaid Program Integrity Activities

The federal government will introduce a number of initiatives to combat Medicaid waste, fraud, and abuse in the coming months. In an article on the Centers for Medicare & Medicaid Services’ blog, CMS administrator Seema Verma outlined her agency’s major Medicaid program integrity efforts of the past year, including: Oversight of state Medicaid claiming and program integrity Disallowing unallowable claims of federal funding Increased audits and oversight Data sharing and partnerships Education, technical assistance, and collaboration Reducing improper payments Initiatives to be introduced in the coming months include (as described in the blog post): A proposed comprehensive update to Medicaid’s [...]

iqtsupport2019-07-03T10:12:38-04:00July 3, 2019|Centers for Medicare & Medicaid Services, Medicaid|