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Medicaid Integrity Program - General Information

The Centers for Medicare & Medicaid Services (CMS) is committed to combating Medicaid provider fraud, waste, and abuse which diverts dollars that could otherwise be spent to safeguard the health and welfare of Medicaid recipients.  In February 2006, the Deficit Reduction Act (DRA) of 2005 was signed into law and created the Medicaid Integrity Program (MIP) under section 1936 of the Social Security Act (the Act).  The MIP is the first comprehensive Federal strategy to prevent and reduce provider fraud, waste, and abuse in the $300 billion per year Medicaid program. (For Medicaid Program - General Information, click on the "Related Links" below.)

CMS has two broad responsibilities under the Medicaid Integrity Program:

  • To hire contractors to review Medicaid provider activities, audit claims, identify overpayments, and educate providers and others on Medicaid program integrity issues
  • To provide effective support and assistance to States in their efforts to combat Medicaid provider fraud and abuse

What's New in Program Integrity: Check here for updates, announcements, and information about the MIP activities.

Medicaid Program Integrity Education Educational resources, tools, and other media to educate providers, beneficiaries and other stakeholders in promoting best practices and to enhance awareness of Medicaid fraud, waste and abuse. 

Along with these responsibilities, section 1936 of the Act requires that CMS develop a five-year Comprehensive Medicaid Integrity Plan (CMIP) in consultation with internal and external partners.

CMS is also required to Report to Congress annually on the effectiveness of the use of funds appropriated for the MIP.

Although the States are primarily responsible for combating fraud in the Medicaid program, CMS provides technical assistance, guidance and oversight in these efforts. Fraud schemes often cross state lines, and CMS strives to improve information sharing among the Medicaid programs and other stakeholders.  Therefore, additional sections of this Web site include:

 

  • How to Report Fraud and Suspected Fraud provides information on how to report cases of suspected Medicaid fraud and abuse to the appropriate agencies.
  • Provider Audits provides information on the MIP's procurement of Audit Medicaid Integrity Contractors (Audit MICs) to conduct provider audits throughout the country.
  • State Program Integrity Support & Assistance provides information on the technical assistance, guidance, training and other support to States to assist in their efforts to combat Medicaid fraud, waste, and abuse.

 Other information and resources on Medicaid program integrity can be found in the Related Links below.

 

  • Deficit Reduction Act (DRA) of 2005: provides information on the DRA, the legislation which created the MIP.
  • Medicaid National Correct Coding Initiative (NCCI) Program: implements NCCI methodologies in State Medicaid programs to reduce improper coding and inappropriate payment of Medicaid claims. (Click on the "Related Links" below.
  • Medicare Fraud - How to Report: provides instructions on how to report suspected cases of Medicare fraud to the appropriate agencies. (Click on the "Related Links" below.)
  • Office of Inspector General (OIG) - Fraud: links to the HHS-OIG Fraud Web site. (Click on the "Related Links" below.)  
  • State Medicaid Director (SMD) Contacts: provides contact information for State Medicaid Directors for each State, the District of Columbia, and the U.S. Territories. (Click on the "Related Links" below.)
  • Medicaid Fraud Control Unit (MFCU) Contacts: provides contact information for State Medicaid Fraud Control Units. (Click on the "Related Links" below.)