Program Integrity in Medicaid Managed Care

This presentation shares findings from a MACPAC study conducted with Booz, Allen, and Hamilton on program integrity practices in Medicaid managed care. In addition to an environmental scan of state and federal practices, the study included interviews in summer and fall 2016 with managed care organizations, Medicaid fraud control units, state Medicaid agencies, and federal agencies, including the Center for Medicare & Medicaid Services and the U.S. Department of Health and Human Services Office of Inspector General. Findings cover current program integrity implementation, best practices, and strengths and weaknesses of the new Medicaid managed care rule as it relates to program integrity.