CPI

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

The National Correct Coding Initiative provides resources for Medicare and Medicaid providers to ensure proper claim coding.

Healthcare Fraud Prevention Partnership (HFPP)

The Healthcare Fraud Prevention Partnership continues to grow, with more than 270 partners sharing the goal of eliminating healthcare fraud, waste, and abuse.

Open Payments

Learn about the Open Payments program, promoting transparency of the $10.9 billion in payments made to providers and hospitals in 2021.

Annual Wellness Visit

View the Annual Wellness Visits video created to help health care professionals understand the requirements for documenting annual wellness visits.

 

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

Focus

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:
02/02/2023 09:55 AM