Milliman proposes provider partnership approach to reduce waste and abuse beyond fraud enforcement

This white paper argues that while fraud enforcement in healthcare has reached record levels, waste and abuse represent larger sources of overspending that require different strategies than traditional program integrity approaches. The authors distinguish between fraud, waste, and abuse as separate problems requiring tailored solutions, and propose five evidence-based approaches for Medicaid and Medicare payers to address waste and abuse through collaboration with providers rather than purely adversarial enforcement. The analysis is particularly relevant for MCO compliance teams balancing program integrity requirements with provider network relationships.

Managed Care · Finance

This is outside commentary from Milliman, not part of Medicaid Monitor's independently scored news coverage.

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