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payment-integrity

Payment Integrity

The Payment Integrity Priority Area is focused on demonstrating stewardship of taxpayer dollars by reducing monetary loss and making payments correctly the first time.

Goal Statement

The Payment Integrity Priority Area is focused on demonstrating stewardship of taxpayer dollars by reducing monetary loss and making payments correctly the first time.

Challenges

While improper payments may compromise citizens' trust in government, they are not always indicative of fraud, nor do they necessarily represent payments that should not have been made. Having the right information and the capacity to address root causes are critical components.

Opportunities

The Payment Integrity Priority Area works to improve the efficiencies of government programs by focusing on getting government payments right the first time they are made and reducing the cost associated with an incorrect payment.

Additionally, this Priority Area builds trust in government by better understanding the nature of improper payments and their relationship to payment integrity.

The Payment Integrity Priority Area strategic approach is featured below:

The Getting Payments Right Priority Area strategic approach features the following 5 strategies. These strategies build on one another. Strategy 1: Clarify and Streamline Requirements -- Reduce burden and improve compliance to allow program resources to focus on preventing improper payments that result in monetary loss. Strategy 2: Identify Monetary Loss Root Causes -- Identify points(s) in the payment process where improper payments occur that result in monetary loss. Strategy 3: Strategic Data Use -- Identify data sets/analysis techniques and link to root causes. Obtain needed data to improve capacity to prevent and detect improper payments. Strategy 4: Mitigation Strategies -- Identify non-data related mitigation strategies and best practices to preventing improper payments and share them across the government. Strategy 5: Strengthen Partnership States -- Identify opportunities to partner with States to improve improper payment detection and prevention capabilities in federally funded state-administered programs. Enlarge
The Getting Payments Right Priority Area strategic approach features the following 5 strategies. These strategies build on one another. Strategy 1: Clarify and Streamline Requirements -- Reduce burden and improve compliance to allow program resources to focus on preventing improper payments that result in monetary loss. Strategy 2: Identify Monetary Loss Root Causes -- Identify points(s) in the payment process where improper payments occur that result in monetary loss. Strategy 3: Strategic Data Use -- Identify data sets/analysis techniques and link to root causes. Obtain needed data to improve capacity to prevent and detect improper payments. Strategy 4: Mitigation Strategies -- Identify non-data related mitigation strategies and best practices to preventing improper payments and share them across the government. Strategy 5: Strengthen Partnership States -- Identify opportunities to partner with States to improve improper payment detection and prevention capabilities in federally funded state-administered programs.

Below is the Executive Steering Committee organizational structure for the Payment Integrity Priority Area:

Hierarchy Row 1 (from top): Executive Steering Committee (Lead: OMB, HHS-CMS, DOL, Treasury) Hierarchy Row 2: Clarify and Streamline Requirements (Strategy Executive: OMB) Improper Payment Definition (12/17 - 5/18 COMPLETE) Improper Payment Reporting (12/17 - 5/18 COMPLETE) Risk Assessment (12/17 - 5/18 COMPLETE) Statutory Changes (12/17 - 5/18 COMPLETE) Root Cause and Eligibility Criteria Reporting Model Guidance Update (3/20-6/20) Payment Integrity Information Act Implementation Guidance (4/20-9/20) Monetary Loss Root Causes (Strategy Executive: TBD) Root Cause Identification (12/18-5/19 COMPLETE) Identity (Phase 1) (7/19-1/20 COMPLETE) Tolerable Level of Improper Payments Evaluation (TBD) Quantifying Identity (3/20-7/20) Strategic Data Use (Strategy Executive: Treasury) Dataset and Eligibility Criteria Identification (12/18-5/19 COMPLETE) Preliminary Data Access Identification (7/19-1/20 COMPLETE) Preliminary Eligibility Pilot Project (1/20-3/22) Data Access Identification & Data Element/Eligibility Requirements (3/20-8/20) Mitigation Strategies (Strategy Executive: VA) Leveraging Existing Strategies to Reduce Monetary Loss (7/19-2/20 COMPLETE) Non-data Dependent Strategy Mapping to Monetary Loss Root Causes (12/19-2/20 COMPLETE) Education and Mitigation Strategy Pilot Evaluation (3/20-5/20) Pilot Development and Implementation (6/20-5/21) Partnership with States (Strategy Executive: Treasury) Federally Funded State Administered Program Evaluation (5/19-8/19 COMPLETE) States Partnership (4/20-1/21) Enlarge
Hierarchy Row 1 (from top): Executive Steering Committee (Lead: OMB, HHS-CMS, DOL, Treasury) Hierarchy Row 2: Clarify and Streamline Requirements (Strategy Executive: OMB) Improper Payment Definition (12/17 - 5/18 COMPLETE) Improper Payment Reporting (12/17 - 5/18 COMPLETE) Risk Assessment (12/17 - 5/18 COMPLETE) Statutory Changes (12/17 - 5/18 COMPLETE) Root Cause and Eligibility Criteria Reporting Model Guidance Update (3/20-6/20) Payment Integrity Information Act Implementation Guidance (4/20-9/20) Monetary Loss Root Causes (Strategy Executive: TBD) Root Cause Identification (12/18-5/19 COMPLETE) Identity (Phase 1) (7/19-1/20 COMPLETE) Tolerable Level of Improper Payments Evaluation (TBD) Quantifying Identity (3/20-7/20) Strategic Data Use (Strategy Executive: Treasury) Dataset and Eligibility Criteria Identification (12/18-5/19 COMPLETE) Preliminary Data Access Identification (7/19-1/20 COMPLETE) Preliminary Eligibility Pilot Project (1/20-3/22) Data Access Identification & Data Element/Eligibility Requirements (3/20-8/20) Mitigation Strategies (Strategy Executive: VA) Leveraging Existing Strategies to Reduce Monetary Loss (7/19-2/20 COMPLETE) Non-data Dependent Strategy Mapping to Monetary Loss Root Causes (12/19-2/20 COMPLETE) Education and Mitigation Strategy Pilot Evaluation (3/20-5/20) Pilot Development and Implementation (6/20-5/21) Partnership with States (Strategy Executive: Treasury) Federally Funded State Administered Program Evaluation (5/19-8/19 COMPLETE) States Partnership (4/20-1/21)
The Executive Steering Committee membership for the Payment Integrity Priority Area includes:
  • Office of Management and Budget (OMB)
  • Department of Labor (DoL)
  • Department of Treasury
  • Department of Health and Human Services (HHS) / Center for Medicaid and Medicare Services (CMS)

12/16/2020

CAP Goal #9 “Getting Payments Right”

CAP Goal #9 “Getting Payments Right,” CAP Goal Action Plan slide deck updated and posted to Performance.gov, updating the strategy and goal leads and highlighting 2019 Q4 accomplishments.

04/08/2020

Initial meeting of CAP Goal #9 Working Group

Initial meeting of CAP Goal #9 Working Group - Root Causes and Eligibility Criteria Reporting. The Root Causes and Eligibility Criteria working group will seek to identify and categorize different eligibility root causes of improper payments.

12/16/2019

2019 Quarterly Key Priority Indicators posted to Paymentaccuracy.gov

2019 Quarterly Key Priority Indicators (KPI) Scorecards posted to Paymentaccuracy.gov and Performance.gov websites. KPI Scorecards are for high-priority programs to highlight quarterly goals and accomplishments.