Verma puts Medicaid insurers on notice, says CMS will begin ‘targeted audits’

Seema Verma
Verma said CMS will begin auditing Medicaid plan sponsors to ensure provider claims match financial reports. (YouTube)

Centers for Medicare & Medicaid Services Administrator (CMS) Seema Verma issued a warning to Medicaid plan sponsors on Thursday, warning the agency would begin targeted financial audits.

The warning came as Verma vowed to bring more transparency to the Medicaid program and “ensuring that states put up their fair share of state matching funds.”

“Transparency must also extend to our health plan partners,” Verma said during remarks at the 2018 Medicaid Managed Care Summit. “This room understands well that nearly all newly eligible individuals in Medicaid are served through managed care organizations. I’m putting you on notice now: CMS will begin targeted audits to ensure that provider claims for actual health care spending matches what the health plans are reporting financially.”


Driving Engagement in an Evolving Healthcare Ecosystem

Deep-dive into evolving consumer expectations in healthcare today and how leading providers are shaping their infrastructure to connect with patients through virtual care.

Moments later, Verma praised plan sponsors for their role in delivering quality care to Medicaid beneficiaries.

“I have seen firsthand the value that you bring to your partnership with states, and the resources that you can often bring to bear to serve the needs of our enrollees on the front lines,” she said.

CMS did not respond to a request to clarify when the audits would begin.

Verma also signaled that CMS is moving forward with Medicaid work requirements despite a court ruling that struck down the agency’s approval of Kentucky’s waiver. She said the agency has finalized a work requirements demonstration waiver which it plans to announce “very soon.”

RELATED: HHS 'undeterred' by court decision striking down Kentucky's Medicaid work requirements

Citing conservative writer Arthur Brooks, Verma argued that the work requirements were not intended to “just kick people off Medicaid” but “put beneficiaries in control with the right incentives to live healthier independent lives.”

“I have heard the criticisms and felt the resistance, but I reject the premise, and here is why: It is not compassionate to trap people on government programs or create greater dependency on public assistance as we expand programs like Medicaid,” she said. “True compassion is giving people the tools necessary for self-sufficiency.”

Suggested Articles

The Supreme Court will decide whether to reinstall Arkansas and New Hampshire's controversial Medicaid work requirements program.

The latter half of 2020 has seen the 340B program in turmoil.

CMS' most-favored-nation drug payment model isn't likely to lower most Medicare beneficiaries' out-of-pocket costs, an Avalere analysis found.