United States

Traveling the 'Final mile' to reduce Medicaid fraud, waste and abuse

Aug 01, 2014
From the Government Institute

Risk of fraud, waste and abuse in healthcare is significant, given the sheer magnitude and nature of the $2.7 trillion (and growing) in annual healthcare spending nationwide.

Criminals go where the money is. The Medicaid program is a large target, given the roughly $460 billion spent in 2013. Officials clearly recognize the critical need to win the war against Medicaid improper payments given the impact on strained government budgets and reduced taxpayer confidence in government as a financial steward.

Building on an earlier study into improper payments, the KPMG Government Institute conducted research into selected state government approaches to preventing, deterring, detecting and responding to Medicaid fraud, waste and abuse. States that have successfully taken their Medicaid integrity programs the “final mile” have been able to pull their various tools and practices together in an organized way, so components of the integrity program work in tandem for optimum results.

This Issue Brief summarizes our research results, which will be detailed in an upcoming white paper that will cover the challenges and provide perspectives on leading practices in Medicaid integrity programs.