Most Medicaid managed care plans are paid predetermined, per-member-per-month capitation payments to cover and coordinate all Medicaid services used by their enrollees. These payments must be ...

The Deficit Reduction Act of 2005 provided the resources to establish the Medicaid Integrity Program (MIP), the first national strategy in the 40-year history of the Medicaid program to promote the ...

On February 25, 2026, the Centers for Medicare & Medicaid Services (“CMS”) announced several program integrity actions impacting Medicaid funding and Medicare supplier enrollment, along with a request ...

Medicaid is the joint federal-state health insurance program that provides medical coverage to almost five million low-income, elderly, disabled Floridians and children. Although the federal ...

On October 3, the Office of Inspector General (OIG) of the US Department of Health and Human Services issued a report titled “UPICs Hold Promise to Enhance Program Integrity Across Medicare and ...

Auditors say the increase coincided with an overall increase in Medicaid enrollment during the first year of the pandemic. The value of improper Medicaid capitation payments made by states to managed ...

Many healthcare delivery organizations have adopted some form of value-based payment model in recent years, shifting the healthcare focus from quantity of services to quality of outcomes. In a ...

* * * Misclassification of Drugs, Program Administration and Program Integrity Updates Under the Medicaid Drug Rebate Program Notice for Proposed Rulemaking (CMS-2434-P) The Centers for Medicare & ...

A new federal review from the U.S. Centers for Medicare & Medicaid Services shows Minnesota’s Medicaid program has an improper payment rate far below the national ...