State Program Integrity Reviews

State Program Integrity Reviews

State Program Integrity offices are on the front line of the fight to combat fraud, waste, and abuse in Medicaid. The Centers for Medicare & Medicaid Services (CMS) supports those efforts with regular state level reviews. From 2007-2013 CMS conducted comprehensive reviews of each state’s Medicaid Program Integrity (PI) activities and reported findings and recommendations to states. The comprehensive reviews involved an in-depth assessment of the state’s PI activities:

  • Regulatory compliance
  • Surveillance and utilization systems
  • Case tracking
  • Pre-payment and post-payment review
  • Provider enrollment and disclosures
  • Interactions with the state's Medicaid Fraud Control Unit (MFCU)
  • Oversight of managed care operation

As a companion to the comprehensive reviews, CMS created Frequent Findings reports. These toolkits were designed to help states better understand requirements and improve compliance with regulations for provider disclosures, federal database checks, and reporting adverse actions taken against providers to HHS-OIG.

Beginning in 2014, CMS began conducting focused reviews. Focused reviews are conducted to determine the extent of program integrity (PI) oversight of the Medicaid program by the States. Traditionally, these reviews have focused on high risk areas of managed care, Affordable Care Act provisions, personal care services and non-emergency medical transportation.

These reviews are designed to identify risks and vulnerabilities to the Medicaid program and assist states with strengthening program integrity operations. The significance and value of performing onsite program integrity reviews include:

  • Assess the effectiveness of the state’s PI efforts, including compliance with certain Federal statutory and regulatory requirements
  • Identify risks and vulnerabilities to the Medicaid program and assist states to strengthen PI operations
  • Help inform CMS in developing future guidance to states
  • Help prepare states with the tools to improve PI operations and performance

Annual Summary Reports

Search below for comprehensive and focused reports by state or year.

Date Fiscal Year State / Territory Type of Report
2007-11-01
2007
Connecticut
Comprehensive
2008-03-01
2007
Nevada
Comprehensive
2008-05-01
2007
Arkansas
Comprehensive
2008-06-01
2007
Delaware
Comprehensive
2008-07-01
2007
Missouri
Comprehensive
2008-07-01
2007
Michigan
Comprehensive
2008-07-01
2008
Oklahoma
Comprehensive
2008-09-01
2007
Oregon
Comprehensive
2008-11-01
2007
Virginia
Comprehensive
2008-11-01
2008
Iowa
Comprehensive
2008-11-01
2008
Texas
Comprehensive
2008-12-01
2008
Georgia
Comprehensive
2008-12-01
2008
North Dakota
Comprehensive
2008-12-01
2008
Illinois
Comprehensive
2008-12-01
2008
Wyoming
Comprehensive
2008-12-01
2008
North Carolina
Comprehensive
2009-01-01
2008
South Carolina
Comprehensive
2009-01-01
2008
South Dakota
Comprehensive
2009-01-01
2008
New York
2009-01-01
2008
Utah
Comprehensive
2009-02-01
2008
Minnesota
Comprehensive
2009-03-01
2008
New Mexico
Comprehensive
2009-04-01
2009
New Hampshire
Comprehensive
2009-07-01
2008
Pennsylvania
Comprehensive
2009-07-01
2009
Maine
Comprehensive
2009-08-01
2008
Wisconsin
Comprehensive
2009-08-01
2008
Vermont
Comprehensive
2009-09-01
2009
Florida
Comprehensive
2009-09-01
2008
Puerto Rico
Comprehensive
2010-02-01
2009
Arizona
Comprehensive
2010-03-01
2009
Louisiana
Comprehensive
2010-03-01
2008
Idaho
Comprehensive
2010-04-01
2009
Alabama
Comprehensive
2010-08-01
2009
District of Columbia
Comprehensive
2010-08-01
2008
Tennessee
Comprehensive
2010-08-01
2009
Mississippi
Comprehensive
2010-10-01
2009
District of Columbia
Focused
2010-10-01
2009
Kentucky
Comprehensive
2010-12-01
2009
Rhode Island
Comprehensive
2010-12-01
2009
Nebraska
Comprehensive
2010-12-01
2010
New York
Comprehensive
2011-01-01
2009
New Jersey
Comprehensive
2011-01-01
2009
Washington
Comprehensive
2011-01-01
2009
Maryland
Comprehensive
2011-01-01
2010
Delaware
Comprehensive
2011-01-01
2009
California
Comprehensive
2011-01-01
2009
Colorado
Comprehensive
2011-01-01
2010
Kansas
Comprehensive
2011-02-01
2009
Massachusetts
Comprehensive
2011-02-01
2010
Arkansas
Comprehensive
2011-02-01
2010
Indiana
Comprehensive
2011-02-01
2009
West Virginia
Comprehensive
2011-02-01
2010
Ohio
Comprehensive
2011-03-01
2010
Virginia
Comprehensive
2011-03-01
2010
Alaska
Comprehensive
2011-03-01
2010
Nevada
Comprehensive
2011-04-01
2010
Texas
Comprehensive
2011-04-01
2010
Missouri
Comprehensive
2011-05-01
2010
Iowa
Comprehensive
2011-06-01
2011
Idaho
Comprehensive
2011-06-01
2010
Oregon
Comprehensive
2011-07-01
2010
Michigan
Comprehensive
2011-08-01
2010
Connecticut
Comprehensive
2011-08-01
2011
Oklahoma
Comprehensive
2011-08-01
2010
Montana
Comprehensive
2011-09-01
2010
Hawaii
Comprehensive
2011-09-01
2011
Vermont
Comprehensive
2011-10-01
2011
South Carolina
Comprehensive
2012-01-01
2011
Utah
Comprehensive
2012-01-01
2011
Puerto Rico
Comprehensive
2012-01-01
2011
Wisconsin
Comprehensive
2012-01-01
2011
Illinois
Comprehensive
2012-01-01
2011
Georgia
Comprehensive
2012-02-01
2011
North Dakota
Comprehensive
2012-03-01
2011
Tennessee
Comprehensive
2012-04-01
2011
Wyoming
Comprehensive
2012-04-01
2011
North Carolina
Comprehensive
2012-05-01
2011
New Mexico
Comprehensive
2012-05-01
2011
Pennsylvania
Comprehensive
2012-06-01
2012
Washington
Comprehensive
2012-06-01
2012
New Jersey
Comprehensive
2012-06-01
2011
Minnesota
Comprehensive
2012-07-01
2012
Florida
Comprehensive
2012-08-01
2012
Massachusetts
Comprehensive
2012-08-01
2012
Maine
Comprehensive
2012-11-01
2012
New Hampshire
Comprehensive
2012-11-30
2012
California
Comprehensive
2012-12-04
2013
Rhode Island
Comprehensive
2013-01-01
2012
Nebraska
Comprehensive
2013-01-01
2013
West Virginia
Comprehensive
2013-01-01
2012
Arizona
Comprehensive
2013-01-03
2012
Colorado
Comprehensive
2013-02-15
2012
Mississippi
Comprehensive
2013-05-22
2012
Maryland
Comprehensive
2013-05-22
2012
Kentucky
Comprehensive
2013-06-01
2012
Alabama
Comprehensive
2013-12-31
2012
Louisiana
Comprehensive
2014-01-31
2013
Arkansas
Comprehensive
2014-02-01
2012
District of Columbia
Comprehensive
2014-02-21
2013
Alaska
Comprehensive
2014-02-28
2013
Montana
Comprehensive
2014-06-28
2013
Hawaii
Comprehensive
2014-07-31
2013
New York
Comprehensive
2014-07-31
2013
Kansas
Comprehensive
2014-08-01
2013
Ohio
Comprehensive
2014-10-01
2013
Michigan
Comprehensive
2014-12-31
2013
Oregon
Comprehensive
2014-12-31
2013
Georgia
Comprehensive
2015-01-01
2013
North Dakota
Comprehensive
2015-01-01
2013
Iowa
Comprehensive
2015-01-01
2013
South Dakota
Comprehensive
2015-01-31
2013
Indiana
Comprehensive
2015-09-01
2014
New Mexico
Focused
2015-09-01
2014
Illinois
Focused
2015-12-01
2014
Minnesota
Focused
2015-12-01
2014
District of Columbia
Focused
2015-12-31
2014
Massachusetts
Focused
2015-12-31
2015
Tennessee
Focused
2016-01-31
2014
New Jersey
Focused
2016-02-01
2014
Michigan
Focused
2016-02-02
2014
Ohio
Focused
2016-02-16
2015
Delaware
Focused
2016-03-01
2015
Nevada
Focused
2016-03-01
2015
Pennsylvania
Focused
2016-03-01
2014
New York
Focused
2016-03-25
2014
California
Focused
2016-05-03
2015
North Carolina
Focused
2016-05-03
2015
Missouri
Focused
2016-05-03
2015
Connecticut
Focused
2016-07-05
2015
Wisconsin
Focused
2016-08-02
2016
Puerto Rico
Focused
2016-10-04
2015
Vermont
Focused
2016-12-01
2015
Texas
Focused
2017-02-01
2016
Virginia
Focused
2017-03-07
2016
Maryland
Focused
2017-05-01
2016
Kentucky
Focused
2017-05-31
2016
New Hampshire
Focused
2017-06-01
2016
Rhode Island
Focused
2017-06-01
2016
West Virginia
Focused
2017-06-01
2016
Nebraska
Focused
2017-06-01
2016
South Carolina
Focused
2017-06-01
2016
Utah
Focused
2017-07-28
2016
Alabama
Focused
2017-07-28
2017
Arizona
Focused
2017-08-01
2017
District of Columbia
Focused
2017-08-01
2017
Louisiana
Focused
2017-10-02
2017
Colorado
Focused
2017-11-01
2017
Indiana
Focused
2018-01-01
2017
Iowa
Focused
2018-01-03
2017
Florida
Focused
2018-02-01
2017
South Dakota
Focused
2018-03-30
2017
Mississippi
Focused
2018-04-30
2017
New York
Focused
2018-11-01
2018
Oregon
Focused
2018-11-30
2018
Georgia
Focused
2018-12-03
2018
Arkansas
Focused
2018-12-03
2018
Wyoming
Focused
2019-01-01
2018
Kansas
Focused
2019-01-04
2018
Washington
Focused
2019-01-08
2018
Idaho
Focused
2019-01-08
2018
Illinois
Focused
2019-01-09
2018
Minnesota
Focused
2019-01-31
2018
Oklahoma
Focused
2019-01-31
2018
Texas
Focused
2019-01-31
2018
Delaware
Focused
2019-07-01
2019
North Dakota
Focused
2019-07-01
2019
Tennessee
Focused
2019-10-01
2019
Ohio
Focused
2019-10-31
2019
Connecticut
Focused
2019-11-01
2019
Maine
Focused
2020-02-01
2019
Massachusetts
Focused
2020-02-01
2019
Montana
Focused
2020-02-01
2019
Pennsylvania
Focused
2020-03-01
2019
New Jersey
Focused
2020-03-01
2019
Vermont
Focused
2020-03-02
2019
Missouri
Focused
2020-03-02
2019
New Mexico
Focused
2020-03-02
2019
New Jersey
Focused
2021-12-01
2021
Alabama
2022-01-01
2021
Iowa
2022-02-01
2021
West Virginia
2022-04-01
2021
Rhode Island
2022-05-01
2021
Kentucky
2022-05-01
2021
Wisconsin
2022-06-01
2021
Michigan
2022-06-01
2021
Utah
2022-10-17
2021
Maryland
2022-10-17
2021
Nevada
2022-10-17
2021
Virginia
2022-10-18
2021
South Carolina
2023-04-03
2022
Nebraska
Focused
2023-04-05
2022
Hawaii
2023-05-17
2022
Arizona
Focused
2023-05-17
2022
Colorado
Focused
2023-06-01
2022
Mississippi
Focused
2023-06-01
2022
New Hampshire
Focused
2023-08-01
2022
District of Columbia
Focused
2023-09-01
2022
California
Focused
2023-10-10
2022
Indiana
Focused
2023-10-10
2022
Louisiana
Focused
2023-10-10
2022
South Dakota
Focused
2024-02-08
2022
Alaska
Comprehensive
2024-03-13
2022
North Carolina
Focused
Page Last Modified:
09/06/2023 04:57 PM