#United States #Miami #CLEAR #Healthy Together #Medicaid Fraud

A New Solution to Combat Medicaid Fraud

In the face of escalating challenges surrounding Medicaid program integrity, Healthy Together has announced a groundbreaking partnership with CLEAR, which promises to dramatically improve the accuracy and security of Medicaid enrollments. According to recent statistics from the Centers for Medicare and Medicaid Services (CMS), the United States incurred an astonishing $37.39 billion in improper Medicaid payments in 2025 alone. This figure underscores the urgent need for state agencies to tackle instances of fraud, waste, and abuse that are costing taxpayers billions every year.

The Medicaid Challenge

State agencies have been wrestling with amidst increasing scrutiny from federal oversight bodies. Recent findings indicated that approximately 2.8 million individuals may be improperly enrolled in Medicaid or the Children's Health Insurance Program (CHIP) across multiple states, with overlaps that could cost taxpayers in the region of $14 billion annually. As the demand for state agencies to enhance payment accuracy and improve enrollment integrity intensifies, the landscape necessitates innovative and efficient solutions.

Historically, rectifying issues post-factum through expensive pay-and-chase models has been the norm for state Medicaid programs. However, this approach not only drains resources after money has already been disbursed but also perpetuates inefficiencies within the system.

A Revolutionary Partnership

To address these issues, Healthy Together, known for its technology partnerships with state health and human services agencies, has teamed up with CLEAR. The core of this partnership is the integration of CLEAR1, a secure identity platform that leverages biometric verification. By utilizing Healthy Together's AI functionality alongside CLEAR1, this initiative aims to reinforce enrollment integrity at the very outset of each application.

When an applicant begins their enrollment journey using Healthy Together’s state-of-the-art technology, they will be prompted to verify their identity through CLEAR. Upon obtaining the necessary consent, their verified identity can be cross-referenced with real-time eligibility and coverage information. This real-time verification will furnish state agencies with the crucial data needed to make informed decisions right within their existing operational workflows.

Immediate Impact and Future Vision

Jared Allgood, CEO of Healthy Together, emphasized the significance of proactive measures in enhancing Medicaid program integrity, stating, “The future of Medicaid program integrity starts before a claim is ever paid.” By leveraging state-of-the-art cloud-native platforms, Healthy Together and CLEAR aim to provide immediate solutions that can be efficiently deployed without extensive downtimes or the need for costly infrastructural overhauls.

Brett Romanoff, the Executive Vice President of CLEAR, echoed these sentiments. He affirmed that a solid and validated identity system is crucial to healthcare integrity and fraud eradication. The collaboration sets the stage for transforming Medicaid’s enrollment process into a streamlined and secure avenue, enhancing the front door of the program for improved citizen engagement.

As the states grapple with the current climate of Medicaid program integrity priorities, the integration of CLEAR1 within existing infrastructures promises a dual benefit: reducing improper payments and alleviating the administrative burdens faced by county caseworkers in the trenches.

Effective immediately, this innovative approach mandates that state agencies pivot towards identity verification at the point of enrollment, as opposed to waiting until after payments have been issued. By employing this preventive strategy, agencies can expect not only improved payment accuracy but also a significant reduction in downstream fraud investigations.

Conclusion

The partnership between Healthy Together and CLEAR marks a transformative step towards modernizing Medicaid enrollment processes. By employing this integrated approach to identity verification and coverage intelligence, Medicaid agencies can better serve the public, safeguard taxpayer resources, and ultimately create a more efficient benefits delivery system. With initiatives like these, the future of Medicaid could very well look different, as states embark on new paths to combat fraud and waste while protecting the integrity of vital healthcare programs.