CMS UPIC PROGRAM INTEGRITY PRIORITIES FOR 2024

CMS UPIC PROGRAM INTEGRITY PRIORITIES FOR 2024 by Sherri McQueen
I am happy to share with you some of the Medicaid investigative/ audit priorities CMS has
established for our Unified Program Integrity Contractors (UPICs) in the calendar year 2024.
Oversight of Medicaid managed care continues to be a priority for CMS. Building off the work
that was done in five states in 2023, we plan to not only increase the number of states and
managed care plans reviewed, but also review for access to health care in relation to prior
authorization requirements, provider network adequacy, and providing preventive services. CMS
will provide states with more details of this project at an upcoming TAG call. We will also share
additional target areas that the UPICs will be focusing on that are at high risk for improper
payments and/or potential patient harm. I would also highlight that when working with the
UPICs, states may continue to pursue other program integrity issues that arise within the
Medicaid program.
I look forward to collaborating with you on these important program integrity issues. If you have
any questions, please reach out to me directly at Sherri.McQueen@cms.hhs.gov. You can also
reach out to the CMS Business Function Leads listed below.
Midwest:  Shumeka Chandler shumeka.chandler@cms.hhs.gov
West: Eddie Sottong edward.sottong@cms.hhs.gov
Southwest:  Gloria Demosthene gloria.demosthene@cms.hhs.gov
Southeast: Mark Rogers mark.rogers@cms.hhs.gov
Northeast:  George Gentile george.gentile@cms.hhs.gov