Medicaid program integrity training now available

Washington State Health Care Authority sent this bulletin at 12/01/2023 08:00 AM PST

December 1, 2023

Medicaid program integrity training

The Health Care Authority (HCA) has published a new Medicaid program integrity training for providers.

Training areas include:

Pharmacy
Hospital audit
Dental audit
COVID-related issues
General program integrity overview and activities
Summary of audit results for 2022 and description of common issues
Opportunities for improvement

The information provided in this educational intervention is not intended to be a comprehensive detailed account of all legal requirements relevant to compliance with Medicaid program integrity laws and regulations.

The purpose of this document is to share with providers ways that they can ensure Program Integrity in their billing practices.

It also satisfies the law requiring annual training in RCW 74.09.195.

View the training

What is Medicaid program integrity?

Program integrity is federally mandated to protect the integrity of Apple Health (Medicaid) programs. It prevents, identifies, and investigates potential fraud, waste, and abuse within Apple Health. Credible allegations of fraud are referred to the Medicaid Fraud Control Division or other law enforcement. Paid claims and managed care organization (MCO) encounters are reviewed to ensure Apple Health funds are used appropriately.

More information

Visit the Medicaid program integrity webpage for more information.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.