How payment analytics can reduce fraud, waste and abuse in Medicaid programs

Now is the time for states to reconsider the structure, process and technologies behind safety net programs – starting with a few key focus areas to sustain and maintain vital program integrity activities. (Photo: Shutterstock)

The current health care landscape has put a spotlight on the importance of sustaining and supporting all avenues of health care delivery and public health programs. For many states, factors such as unemployment and the economic downturn resulting from the pandemic have led to increased enrollment in safety net programs like Medicaid. At the same time, an uncertain economic landscape has meant decreased revenues and unpredictable budgets. In tandem with managing this influx in safety net program enrollment — a challenge in and of itself — states have also been dealing with the added strain that COVID-19 cases put on the health care system.

In the early months of 2020, various processes, rules and regulations at the national, state and local levels were put on hold or simplified to help increase patient capacity and health care access. Most notably for many patients were the relaxed requirements for telehealth, which enabled providers to rapidly begin offering virtual care to patients.