The Pennsylvania Department of Human Services (DHS) has announced new steps to enhance its program integrity efforts and reduce improper and fraudulent payments, including Medicaid payments.
The proposed new approach will rely heavily on automation, analytics, and technology. Major changes include:

  • pa dhsConsolidation of the Office of Program Integrity and Bureau of Program Integrity
  • Issuing a request for information for program integrity data analysis of provider payments
  • Implementation of a customer portal for third-party liability
  • Implementation of “identity proofing” of program recipients
  • Automating provider enrollment
  • Eliminating manual updating of milestone changes

In the state’s 2015 fiscal year it prevented nearly $600 million in improper payments, 74 percent of which were potential provider payments.
For a closer look at the state’s plans, see this DHS news release.