Nov 04, 2014
From the Government Institute
Risk of fraud, waste, and abuse in government and private healthcare programs is significant, given the sheer magnitude and nature of the $2.8 trillion (and growing) in annual healthcare spending nationwide. The Medicaid program represents a large target, given the about $460 billion spent in 2013. And Medicaid spending will grow with expansion of eligibility though the Affordable Care Act.
States are on the front line in addressing Medicaid improper payments and are making important progress. But a lot remains to be done. One question is how to best capitalize on leading practices. How do states take what they know and what others have learned and put everything together into the “Final Mile” to further reduce improper payments, especially where fraud, waste, and abuse are involved?
The white paper explores KPMG research into selected state government approaches to preventing, deterring, detecting, and responding to Medicaid fraud, waste, and abuse. This paper summarizes key challenges and leading practices used by states in addressing the risk of improper payments in Medicaid and provides perspectives on leading practices in Medicaid integrity programs.
States able to go the "Final Mile" leverage leading-edge analytic tools. Their staffs have the requisite knowledge, skills, and abilities. They continually refine their integrity programs to take advantage of leading practices and new technology. And they are able to pull everything together in an organized way, enabling more optimal results.