Program Integrity in Medicaid: A Primer
Medicaid covers more than 60 million Americans and accounts for about one in six dollars spent on health care in the United States. Multiple agencies at the state and federal levels are involved in efforts to prevent waste, fraud and abuse in the program and ensure appropriate use of taxpayer dollars, and many program integrity initiatives are yielding positive results. The Affordable Care Act (ACA) builds on earlier efforts through the Deficit Reduction Act to promote program integrity. This brief examines program integrity in Medicaid, including a look at the entities involved in such efforts and what key initiatives are underway, as well as the central issues in program integrity as Medicaid expands under health reform.