CMS launches new audit initiatives for Medicaid

The Centers for Medicare & Medicaid Services (CMS) announced Tuesday it plans to move forward with a series of wide-ranging transparency and accountability initiatives designed to improve Medicaid oversight and curb wasteful spending.

According to CMS, the newly announced initiatives will emphasize program integrity in audits of state claims for federal match funds and medical loss ratios (MLRs). CMS will also begin auditing state beneficiary eligibility determinations as part of the new initiatives, specifically targeting states that have been previously found to be high risk by the Office of Inspector General (OIG).

In addition to beefing up its Medicaid auditing, CMS also plans on validating the quality and completeness of claims and provider data that states submit to CMS.