Medicaid Alliance for
Program Safeguards
Background
CMS' role of providing technical assistance and guidance to the States in their Medicaid program integrity efforts was established as a discrete function in 1996. In June 1997, CMS' Southern Consortium, which is comprised of the Atlanta and Dallas Regional Offices, assumed leadership for CMS' nationwide Medicaid fraud and abuse activities. This marked the first time that a Regional Office was assigned responsibility for leading a national function and the beginning of the National Medicaid Fraud and Abuse Initiative, which celebrated its third anniversary in June 2000.
On October 30, 2001, the National Medicaid Fraud and Abuse Initiative changed its name to the Medicaid Alliance for Program Safeguards (Alliance). The name change accurately describes the new goals and direction the Alliance has adopted.
Under the Medicaid Alliance for Program Safeguards' precedent-setting organizational structure, an Alliance team, based in CMS' Central Office in Baltimore, reports to the National Coordinator of the Alliance in the Southern Consortium. The Alliance is positioned to be responsive to the states, and ultimately more effective, because it includes a network of Alliance Coordinators who represent all ten of CMS' regional offices across the country. The Regional Office Network Coordinators and the Central Office team enable CMS to exercise oversight through a series of program integrity reviews.
The approach of the Alliance is based on three basic principles:
- Unlike the Medicare program, the states administer their own Medicaid
programs.
- Assisting the states in increasing the effectiveness of their Medicaid
program integrity efforts requires a close working relationship with the states
to remove obstacles to those efforts, and to strengthen and expand the
State/Federal partnership.
- In addition to technical assistance, CMS is responsible for oversight of
states' fraud and abuse efforts. The Alliance's work continues to be
guided by feedback that states provided in a 1997 focus group. As a result of
that "listening session," CMS learned that the states wanted the
Alliance's help to facilitate communication, information sharing, and
establish a national forum for Medicaid fraud and abuse issues. As a direct
response, CMS formed the Medicaid Fraud and Abuse Control Technical Advisory
Group, or "TAG."
The TAG provides a national forum for the states to share issues, solutions, resources and experiences. There are 19 states represented on the TAG, along with three CMS staff members and one state Medicaid Fraud Control Unit. The TAG has established a networking mechanism that ensures that all states are kept informed of its activities. The work of the TAG is supported and complemented by the Alliance's Central Office team and the regional network of Alliance Coordinators.
If you would like to know more about Medicaid fraud and abuse detection and prevention, several products of the Medicaid Alliance for Program Safeguards that may be of interest to you can be found under guidance and reports.
