UPICs hold promise to enhance program integrity across Medicare and Medicaid, but challenges remain

UPICs hold promise to enhance program integrity across Medicare and Medicaid, but challenges remain

Collection:
Health Policy and Services Research
Series Title(s):
Report in brief (United States. Department of Health and Human Services. Office of Inspector General)
Contributor(s):
United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections, issuing body.
Publication:
Washington, D.C. : U.S. Department of Health and Human Services, Office of Inspector General, September 2022
Language(s):
English
Format:
Text
Subject(s):
Fraud -- prevention & control
Government Programs
Government Regulation
Medicaid
Medicare
United States
Centers for Medicare & Medicaid Services (U.S.)
Genre(s):
Technical Report
Abstract:
Why OIG Did This Review. Unified Program Integrity Contractors (UPICs) are the Centers for Medicare and Medicaid Services’ (CMS’s) only program integrity contractors that safeguard both the Medicare fee-for-service (FFS) and the Medicaid programs from fraud, waste, and abuse. Combined, Medicare and Medicaid provided health care coverage to 139 million people at a cost of $1.5 trillion in 2020. Given the cost and scope of these Federal health care programs, it is essential that UPICs successfully detect and deter fraud, waste, and abuse. How OIG Did This Review. We requested and analyzed workload data related to program integrity activities for each of the five UPICs in 2019. In addition, we sent a survey to each UPIC to ask about the challenges it faced in performing these activities. From CMS, we requested and reviewed certain deliverables that UPICs submitted related to their program integrity activities conducted in 2019. We also sent CMS a questionnaire asking about the effects of the unification of Medicare and Medicaid program integrity activities; how CMS measures the effectiveness of UPICs; and any challenges UPICs face in conducting their work. We also asked both UPICs and CMS about the effects of the COVID-19 pandemic on UPICs’ work.
Copyright:
The National Library of Medicine believes this item to be in the public domain. (More information)
Extent:
1 online resource (1 PDF file (38 pages))
Illustrations:
Illustrations
NLM Unique ID:
9918715886706676 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/9918715886706676