CPI Landing

Center for Program Integrity
Protecting the Medicare & Medicaid Programs from Fraud, Waste, and Abuse
Program Integrity Knowledge and Resource Center

Learn about calculating
overpayments with the
latest CPI training

The new Extrapolation/Estimation eLearning course will help you calculate overpayments.
photo of pill bottle, pills, and a stethoscope

$9.23 billion paid to doctors and hospitals
in 2018

The Open Payments program tells you who drug and device companies paid, and how much.
Reduce Medicare Claims Denials

Reduce Medicare
claim denials
and appeals

The Targeted Probe and Educate program is available for providers and suppliers.
Healthcare Fraud Prevention Partnership

Healthcare Fraud Prevention Partnership continues to grow

More than 150 partners with one goal: eliminating health care fraud, waste, and abuse.
 

Who We Are

At the Center for Program Integrity (CPI), our mission is to detect and combat fraud, waste and abuse of the Medicare and Medicaid programs. We do this by making sure CMS is paying the right provider the right amount for services covered under our programs. We work with providers, states, and other stakeholders to support proper enrollment and accurate billing practices. Our work focuses on protecting patients while also minimizing unnecessary burden on providers.

See the complete list of CPI's Leadership Team.

What We Do

 

Provider Enrollment

CPI builds systems and manages programs to enroll providers in the Medicare and Medicaid programs.

Data Analysis

Using predictive analytics, we identify and seek to prevent fraud, waste and abuse. See an example of how data is used to understand the health care landscape with the Market Saturation and Utilization map.

Medical Reviews & Audits

CPI oversees medical reviews and audits to safeguard the Medicare and Medicaid programs from fraud, waste and abuse.

Collaboration with States

CPI offers support and venues for states to collaborate and share best fraud-fighting practices, making the Medicaid program stronger and protecting the care of states’ Medicaid populations.

Our Focus in 2020

Image With Icons Depicting Our Focus in 2020

Protecting Taxpayer Dollars

To enhance and modernize program integrity to combat fraud, waste, and abuse, we’re working to:

  • Implement new program integrity approaches that work for innovative value-based payment programs
  • Leverage new and emerging technology to modernize our program integrity tools
  • Protect enrolled providers while taking aggressive actions to keep out those who seek to defraud the programs
  • Use data to identify and address key risk drivers to mitigate emerging Medicaid eligibility program risks
  • Target services and supplies at a high risk for Medicare fraud for additional review, while reducing provider burden

Stay Up to Date with CPI

Connect with CPI as we host or attend various events throughout the year, join our mailing list to stay informed on Program Integrity news, or find the most appropriate vehicle to report suspected fraud, waste, or abuse.

Page Last Modified:
04/20/2020 12:44 PM