Taming The Wild West: Part 1, The Auditors Are Coming

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Taming The Wild West: Part 1, The Auditors Are Coming

The Medicaid Managed Care Final Rule is substantial and recognizes the impact managed care has had on Medicaid. With initial support from the National Association of Medicaid Directors (NAMD), this rule will have far-reaching impacts and will drive Medicaid administration for decades.


With nearly 75% of Medicaid enrollees and a national policy now laid out, it is evident that Medicaid and CHIP managed care is expected to become the national standard for Medicaid services delivery. Medicaid is already one of if not the most complicated healthcare delivery systems and a thorough understanding of the Final Rule and its impact on quality, access, program integrity, accountability and transparency, and efficiency is vital. This document provides a summary brief of the Medicaid and Children’s Health Insurance Program (CHIP) Programs: Medicaid Managed Care, CHIP Delivered in Managed Care, and Revisions Related to Third Party Liability final rules.


Medicaid Managed Care Final Rule

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Rob Finlayson“The Auditors Are Coming” is the first in a 6-part series, titled Taming the Wild West, written by Robert Finlayson, ex-Chief Investigator over Internal Investigations and Program Fraud, and the ex-Deputy Director over the Program Integrity Division.