State Medicaid agencies: New challenges in the battle against fraud

Agencies are exploring forward-thinking approaches to make sure those truly in need of Medicaid benefits receive them

State Medicaid agencies faced numerous challenges during the pandemic, and with the end of the federal continuous enrollment program this past spring, those challenges are more daunting than ever. This white paper is based on a recent survey of several agencies actively seeking and, in most cases, using software programs and service providers to help them handle their most significant challenges — preventing, detecting, and investigating fraud and abuse.

When it comes to proactively preventing and detecting fraud, state agencies have a clear preference for software over outside services. Cost-effectiveness and data protection are among the significant reasons for this preference.

State Medicaid agencies are committed to providing benefits to those truly in need while stopping fraudsters from using false identities to steal federal funds. That commitment extends to finding the best tools to help them fulfill that mission and effectively meet the many challenges associated with preventing fraud.

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