Strengthen Program Integrity Before Federal Scrutiny Intensifies
HMA helps state Medicaid agencies assess program integrity risk, strengthen oversight, improve audit readiness, and align operations with federal and state expectations. Our work supports agencies that need to modernize governance, provider screening, SIU processes, analytics, managed care oversight, and corrective action planning.
Why Program Integrity Matters for State Medicaid Agencies
CMS is directing rapid provider revalidation, expanding analytics enforcement, and initiating federal actions involving 13 states. States should assess capabilities now and demonstrate audit readiness before federal scrutiny intensifies.
What Healthcare Providers Engage HMA For
Are your program integrity capabilities structured, governed, and resourced to withstand federal scrutiny while supporting financial and operational performance?
Program Integrity Risk Assessment
Evaluate governance, controls, SIU/program integrity unit, provider screening, analytics, audit defensibility
Audit Readiness Planning
Develop prioritized roadmap aligned to CMS and HHS OIG expectations
Operational Transformation
Governance restructuring, policy development, workflow redesign, provider oversight enhancement
Enterprise Data Integration
Connect claims, encounters, provider enrollment, investigation records into analytical environment
Continuous Monitoring & Reporting
Dashboards and compliance frameworks for sustained improvement
Why State Medicaid Agencies Trust HMA
State Medicaid agencies need program integrity strategies that can withstand federal scrutiny while working within real operational constraints. HMA combines Medicaid policy, program integrity, analytics, and operational experience to help agencies assess risk, strengthen oversight, and prioritize actions that improve compliance, financial protection, and audit readiness.
- Reduce federal and state audit exposure through objective assessment
- Align with CMS, HHS OIG, and state expectations by staying current on federal priorities
- Quantify financial exposure and opportunity
- Deliver practical roadmap balancing speed with sustainability
- Team includes former state Medicaid directors and program integrity directors (we understand state operations + federal expectations)
Frequently Asked Questions
We’re already spending on program integrity. Why add a consultant?
Most states have fragmented capabilities. Compliance, SIU/program integrity, payment integrity, provider enrollment, and analytics operate independently. This costs money (duplicate efforts, slow response), creates risk (gaps go undetected), and undermines defensibility. We help you work smarter.
Talk with an HMA expert to identify exposure, clarify expectations, and prioritize high-impact next steps.
Click To Schedule a Consultation
