States continue to pursue a variety of program integrity strategies despite limited information about which ones generate the most value for the investment. In 2012, the Commission recommended that the Secretary of the U.S. Department of Health and Human Services should determine which Medicaid program integrity activities are most effective and improve dissemination of best practices in program integrity. However, there has been little progress towards this goal.
This presentation offers the rationale for potential June 2019 recommendations that (1) the federal government establish state-level Medicaid program integrity demonstrations and use the results to help improve their program integrity activities, and (2) a statutory change be made to give states the option, rather than requiring them, to contract with a recovery audit contractor.