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Medicaid is a large source of spending in both state and federal budgets, making program integrity efforts important to prevent waste, fraud, and abuse and ensure appropriate use of taxpayer dollars. This brief explains what program integrity is, recent efforts at the Centers for Medicare and Medicaid Services (CMS) to address program integrity, and current and emerging issues.
Medicaid covers more than 60 million Americans and accounts for about one in six dollars spent on health care in the United States.
Headlines regularly call attention to pockets of fraudulent activity in the health care arena - scams that amount to millions and potentially billions of dollars. The stories typically focus on catching the crooks but not so much on efforts to prevent fraud, waste and abuse in health care programs. Both types of efforts are important.
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