The New Medicaid Integrity Program: Issues and Challenges in Ensuring Program Integrity in Medicaid

This paper analyzes the Medicaid Integrity Program, a new federal effort within the Centers for Medicare and Medicaid Services that was enacted as part of the Deficit Reduction Act of 2005 to ensure program integrity in Medicaid.

This paper defines program integrity as ensuring that health and long-term care services are provided to beneficiaries effectively and efficiently, with a goal of ensuring that quality care and tax dollars are not being put at risk through violations of the rules or abuses of the system. The analysis in this paper relies on reviews of the existing literature and perspectives provided by a group of experts in program integrity in Medicaid.

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