Program Integrity: eBulletins
eBulletins are the newest education material being developed in the ongoing efforts to further educate providers, stakeholders, pharmacists, beneficiaries, and the general public to continue to combat fraud, waste, and abuse in the Medicaid program.
Our first eBulletin focuses on Provider Enrollment Requirements (PDF) and addresses the mandatory disclosures as they pertain to Medicaid program integrity.
Home and Community-Based Waiver Services Snapshot (PDF) eBulletin covers waiver programs for HCBS.
The eBulletin The Role of Brokers in the Medicaid Program Snapshot (PDF) discusses the use and roles of independent contractors/brokers in the Medicaid program.
Provider Enrollment: Disclosure of Ownership and Control Snapshot (PDF) talks about the disclosures that providers are required to report when applying for enrollment.
Learn about the various databases CMS recommends State Medicaid Agencies check when verifying provider identity by reviewing Checking Federal Databases to Verify Provider Identity Snapshot (PDF).
Medicaid Provider Agreements Snapshot (PDF) eBulletin gives an overview of the provider agreement required by State Medicaid Agencies (SMA's).
To learn more about the obligations of corporate providers; please review Corporate Integrity Agreements Snapshot (PDF) eBulletin.
Check out the Claims Audit Snapshot (PDF) eBulletin to learn about the Medicaid provider audit process.
The eBulletin Corrective Actions to Prevent Improper Payments Snapshot (PDF) covers the importance of corrective action plans as they pertain to improper payments.
Fiscal Agents: Disclosure of Ownership and Control Snapshot (PDF) eBulletin discusses the roles and responsibilities of fiscal agents.
Learn about the effects of criminal convictions on providers in our eBulletin The Effect of Criminal Convictions on Medicaid Enrollment Snapshot (PDF).
Medicaid Provider Enrollment Disclosures: Convictions Snapshot (PDF) is an overview of the requirement for Medicaid providers to disclose convictions for their involvement in any offense related to Medicare, Medicaid, or the Children's Health Insurance Program (CHIP).
The eBulletin Introduction to Medicaid Snapshot (PDF) provides some history on the Medicaid program.
Sanctions for Provider Misconduct Snapshot (PDF) reviews the sanctions that can be imposed on providers that engage in fraud, waste, and/or abuse in the Medicaid program.
Screening is required for all fee-for-service providers that participate in the Medicaid and CHIP programs; Medicaid Provider Enrollment Screening Snapshot (PDF) discusses the requirements and process.
Disclosure of Business Transactions with Subcontractors and Wholly Owned Suppliers Snapshot (PDF) provides information about disclosure requirements to prevent kickbacks or other inappropriate business transactions.
Next up is the Payment Suspensions Snapshot (PDF), and it covers the credible allegations standard and the effects of payment suspensions.
The eBulletin Data Analytics Benefits Snapshot (PDF) contains information about the importance of the data obtained by State Medicaid Agencies to aide in preventing fraud, waste, and abuse.
The Medicaid Management Information System Snapshot (PDF) goes over the claims processing and information retrieval system that State Medicaid Agencies must use.
The importance of self-audit is discussed in the Self-Audit Snapshot (PDF) eBulletin.
The Improper Payments Information Act and the Improper Payments Elimination and Recovery Improvement Act are discussed in the Payment Error Rate Measurement Program Snapshot (PDF) eBulletin.
The Medicaid Recovery Audit Contractor Snapshot (PDF) covers the responsibilities of the RACs.
To learn more about state-wide surveillance and utilization review subsystems please review Surveillance and Utilization Review Subsystems Snapshot (PDF).
Please direct questions or requests to Medicaid Provider Education.
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