CMS To Launch Medicaid Program Integrity Workgroup With States


CMS is in the early stages of launching a Medicaid program integrity workgroup that states for months have been pushing the agency to set up as part of a holistic approach to overhauling the Medicaid program integrity arena. An agency official briefly mentioned the workgroup at a Sept. 20 House Oversight health subcommittee hearing where lawmakers highlighted billions of dollars in federal Medicaid overpayments to New York developmental centers. State Medicaid sources are closely watching to see if CMS' plan will match their call for a national effort to elevate the conversation about how Medicaid program integrity works -- or in some cases does not work -- and how the federal government and states can increase their collaboration.

At the hearing, Deputy Director of the Center for Medicaid and CHIP Penny Thompson mentioned the planned workgroup in the context of the problems identified in New York. After studying what led to these overpayments, CMS learned from the New York situation that current methods to enforce the upper payment limits are “not enough to protect federal dollars,” Thompson said, as they did not control excessive rates in New York, and that defined payment methodologies do not ensure appropriate payment rates. CMS also said the New York experience taught the agency that “our state partners themselves must also bear responsibility and accountability to identify anomalous payments and expenditures and address them proactively...when reasonable parameters of economy and efficiency are being breached.”

The participants in the workgroup and when it would convene have not yet been set, a state Medicaid source said. CMS had not answered questions on when the workgroup might be up and running by press time.

At last Thursday's hearing, Thompson told lawmakers that CMS plans to work with the National Association of Medicaid Directors to assemble a group of state Medicaid directors and program integrity subject matter experts to look at improving both financial management and program integrity in the program. Thompson's written testimony said the workgroup will identify best practices for financial management and states would “provide input as CMS develops a framework for measuring Medicaid program integrity return on investment.” The workgroup would also look at collaboration and alignment between Medicare and Medicaid program integrity efforts, the testimony states.

“This workgroup will allow CMS and its state partners to address problems, such as the rate in New York, in a collaborative, comprehensive manner,” Thompson told lawmakers.

At the hearing, the Oversight health subcommittee's fifth on Medicaid fraud, waste and abuse, lawmakers released a report that estimated CMS had made about $15 billion in overpayments to developmental centers in New York. This was a “brazen example of government failure,” committee Vice Chairman Paul Gosar (R-AZ) said, noting that private facilities performing the same functions received about 10 times less funding per patient than Medicaid funded developmental centers in New York. Although CMS noticed that the centers were being paid at rates beyond the actual costs for running the centers in 2007, they did not start working with New York on the problem until 2010, according to written testimony. Thompson said that while CMS is still finalizing new payment methodologies to correct the problem, the final payment rates for the centers are expected to be at about one fifth of current levels.

A state Medicaid source said that while CMS' commitment to developing the workgroup is a good thing, the workgroup envisioned by the states would not solve specific financial management problems like occurred in New York, but rather would take a much broader, more holistic look at program integrity. The workgroup ideally would include not only Medicaid but also Medicare experts, the state Medicaid source said.

But the source agreed with CMS that one goal of such a workgroup should be to develop a framework to measure a return on investment from different programs. One of the challenges to the current Medicaid program integrity is that it is is housed in different program silos and fragmented, which means finding a way to measure a return on investments as a whole is difficult. But CMS needs to go further, the state source said, and allow states to use solid measurement of returns to affect public policy. States should be able to strengthen programs that are shown to work well and cut back on ones that aren't, the source said, as opposed to funding all programs regardless of their performance.

The National Association of Medicaid Directors called for convening a similar task force in its March report on Medicaid Program Integrity. -- Michelle M. Stein (


Written by:
less on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
Privacy Policy (Updated: October 8, 2015):

JD Supra provides users with access to its legal industry publishing services (the "Service") through its website (the "Website") as well as through other sources. Our policies with regard to data collection and use of personal information of users of the Service, regardless of the manner in which users access the Service, and visitors to the Website are set forth in this statement ("Policy"). By using the Service, you signify your acceptance of this Policy.

Information Collection and Use by JD Supra

JD Supra collects users' names, companies, titles, e-mail address and industry. JD Supra also tracks the pages that users visit, logs IP addresses and aggregates non-personally identifiable user data and browser type. This data is gathered using cookies and other technologies.

The information and data collected is used to authenticate users and to send notifications relating to the Service, including email alerts to which users have subscribed; to manage the Service and Website, to improve the Service and to customize the user's experience. This information is also provided to the authors of the content to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

JD Supra does not sell, rent or otherwise provide your details to third parties, other than to the authors of the content on JD Supra.

If you prefer not to enable cookies, you may change your browser settings to disable cookies; however, please note that rejecting cookies while visiting the Website may result in certain parts of the Website not operating correctly or as efficiently as if cookies were allowed.

Email Choice/Opt-out

Users who opt in to receive emails may choose to no longer receive e-mail updates and newsletters by selecting the "opt-out of future email" option in the email they receive from JD Supra or in their JD Supra account management screen.


JD Supra takes reasonable precautions to insure that user information is kept private. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. However, please note that no method of transmitting or storing data is completely secure and we cannot guarantee the security of user information. Unauthorized entry or use, hardware or software failure, and other factors may compromise the security of user information at any time.

If you have reason to believe that your interaction with us is no longer secure, you must immediately notify us of the problem by contacting us at In the unlikely event that we believe that the security of your user information in our possession or control may have been compromised, we may seek to notify you of that development and, if so, will endeavor to do so as promptly as practicable under the circumstances.

Sharing and Disclosure of Information JD Supra Collects

Except as otherwise described in this privacy statement, JD Supra will not disclose personal information to any third party unless we believe that disclosure is necessary to: (1) comply with applicable laws; (2) respond to governmental inquiries or requests; (3) comply with valid legal process; (4) protect the rights, privacy, safety or property of JD Supra, users of the Service, Website visitors or the public; (5) permit us to pursue available remedies or limit the damages that we may sustain; and (6) enforce our Terms & Conditions of Use.

In the event there is a change in the corporate structure of JD Supra such as, but not limited to, merger, consolidation, sale, liquidation or transfer of substantial assets, JD Supra may, in its sole discretion, transfer, sell or assign information collected on and through the Service to one or more affiliated or unaffiliated third parties.

Links to Other Websites

This Website and the Service may contain links to other websites. The operator of such other websites may collect information about you, including through cookies or other technologies. If you are using the Service through the Website and link to another site, you will leave the Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We shall have no responsibility or liability for your visitation to, and the data collection and use practices of, such other sites. This Policy applies solely to the information collected in connection with your use of this Website and does not apply to any practices conducted offline or in connection with any other websites.

Changes in Our Privacy Policy

We reserve the right to change this Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our privacy policy will become effective upon posting of the revised policy on the Website. By continuing to use the Service or Website following such changes, you will be deemed to have agreed to such changes. If you do not agree with the terms of this Policy, as it may be amended from time to time, in whole or part, please do not continue using the Service or the Website.

Contacting JD Supra

If you have any questions about this privacy statement, the practices of this site, your dealings with this Web site, or if you would like to change any of the information you have provided to us, please contact us at:

- hide
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.