CMS Calls on States to Audit and Revalidate Medicaid Providers

The federal government is intensifying its crackdown on Medicaid fraud, and no state is getting a pass.

On April 21, Centers for Medicare and Medicaid Services Administrator Mehmet Oz announced at Politico's Public Health Care Summit that all 50 states have 30 days to submit provider revalidation plans. The directive is straightforward: states must immediately audit and verify every provider being paid through their Medicaid programs, with a specific focus on high-risk areas. The end goal, as Oz put it, is confirming that all Medicaid providers are legitimate.

This is not entirely new territory. Federal regulations have long required state Medicaid agencies to revalidate providers at least once every five years. What is new is the urgency. Centers for Medicare and Medicaid Services (CMS) is no longer willing to wait for the next scheduled cycle. States are being asked to demonstrate compliance now, and they are being told to lean on advanced technology and data analytics to get there. As Oz noted during the summit, data is what points officials to where the fraud actually is.

For providers, the message is clear. If your enrollment records are not clean and your billing and documentation practices cannot hold up under scrutiny, now is the time to get ahead of it. Further details on the initiative are expected to follow shortly.