Medicaid Leaders Advocate for Integrated Program Integrity to Enhance Efficiency
Medicaid programs across the United States are facing increasing challenges due to their growing size, cost, and complexity. As a result, there is a push to integrate program integrity into the daily operations of these programs rather than treating it as a standalone function. This approach aims to address issues such as fraud, waste, and abuse more effectively by embedding checks into everyday processes. The traditional siloed model, which separates eligibility, service delivery, and oversight, is being questioned for its effectiveness. Instead, a team-based approach is being advocated, where responsibility is distributed across the system, allowing for earlier detection and resolution of issues. This model also aims to improve the experience for participants and caregivers by reducing disruptions and administrative burdens. 
