CMS’ recent push for states to revalidate high-risk Medicaid providers is a clear signal: program integrity scrutiny is increasing.
As states work to meet these expectations, Medicaid managed care organizations may be asked to support significant provider validation activity, including site inspections, licensure verification, and operational reviews.
For health plans, this could place added strain on SIU and program integrity teams already managing complex fraud, waste, and abuse priorities.
Site visits are more than a checkbox. They help verify whether a provider location is legitimate, active, properly licensed, and equipped to deliver the services being represented.
CoventBridge has supported CMS and health plans in this work for more than 26 years, with a nationwide network of 700+ investigators across all 50 states and deep experience in field-based program integrity investigations.
As Medicaid oversight evolves, scalable and defensible provider validation will be essential.
