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Myers and Stauffer’s program integrity experts present common challenges – and solutions – to ensure your program is prepared for anything.

State Medicaid programs and Children’s Health Insurance Programs (CHIP) continue to grow and become increasingly complex. This is due, in large part, to the expansion of managed care and alternative payment methods. Plus, legislators, oversight agencies and other stakeholders insist that scarce Medicaid/CHIP dollars be used to deliver high quality services at reasonable costs. It has never been more important to ensure that state program integrity (PI) systems remain flexible and adaptable to the changing health care landscape.

Myers and Stauffer has spent nearly 40 years working with government health programs. We have the experience and expertise to ensure your PI approach stays ahead of the curve. Our impressive team of PI subject matter experts (SME) has real world experience dealing with the challenges you face each and every day. That experience, and the desire to help PI programs get ahead of most issues, led us to put together this list of 10 common challenges PI programs face. How robust is your program? How flexible? Does it provide a significant return on your state’s investment? If the answers to these questions leave you feeling uncertain, Myers and Stauffer can help you enhance your PI program to better address today’s rapidly changing health care environment.

10 Common Challenges PI Programs Face

  • 1. Enrolling providers
  • 2. Protecting the Medicaid managed care environment
  • 3. Identifying vulnerabilities and fraud using predictive and data analytics
  • 4. Developing and maintaining an effective audit program
  • 5. Ensuring contract compliance with all vendors
  • 6. Reviewing member eligibility
  • 7. Collaborating with Medicaid Fraud Control Units and other law enforcement agencies
  • 8. Responding to external stakeholder reviews
  • 9. Developing and maintaining an effective case management system
  • 10. Adapting to alternative payment models and the future

Contact one of our experts for more information on how we can help you tackle your PI challenges!

Ryan Farrell, CFE, co-partner-in-charge
Chuck Smith, CPA, co-partner-in-charge
Kimberly Forrest, RHIA, senior manager
Toni Prine, RPh, senior manager
Bill Root, senior manager
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