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Program Integrity – A Priority for Safety Net Health Plans
The Federal government estimates that, in fiscal year 2015, 9.45% of Medicaid payments were improper: they went to the wrong recipient, were for the wrong amount, lacked documentation, or were used in an improper manner. However, most of these errors occurred in fee-for-service programs and eligibility determinations; the improper payment rate in Medicaid managed care was an estimated 0.12%. To achieve this low error rate, managed care plans devote significant staff and financial resources to preventing, detecting, and investigating fraud, waste, and abuse.
This fact sheet profiles some of the initiatives and activities of five Safety Net Health Plans to ensure program integrity. The featured plans serve low-income individuals in different states with varied regulatory environments and trends and give a good overview of how Safety Net
Health Plans operate in this area.