Program Integrity

CMS Plans Major Upgrade to Faulty Account Transfer Process Between the Federal Marketplace and State Medicaid Agencies

Last week CMS announced plans to replace the technology and processes used to coordinate eligibility and enrollment through electronic accounts between the federal marketplace (healthcare.gov) and states that use the federal platform. The account transfer (AT) process, although riddled with glitches, has been in place since the Affordable Care Act’s coverage expansions began in 2014. […]

Tricia Brooks

October 17, 2024

Trump-appointed Federal Court Judge Undercuts Important Legal Tool Used to Eliminate Health Care Fraud

Ultra-conservative politicians often use the risk of health care fraud to stoke fears about investing in public health care programs like Medicaid and Medicare. The funny thing is, their own judges appear to be working hard to make fraud more common. On September 30, 2024, a Trump-appointed Florida judge issued a radical decision to weaken […]

Leonardo Cuello

October 11, 2024

The Proper Use of Medicaid Improper Payment Rates

For the first time, CMS has posted state-specific rates of improper payments in Medicaid. This welcome exercise in transparency is a sea change in the Payment Error Rate Measurement (PERM) program, which CMS has been using since 2007 to help states improve the accuracy of their Medicaid payments. Until now, CMS has been reporting only […]

Andy Schneider

January 26, 2022