Medicaid Integrity Program

Background

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. CMS is 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. 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

On these pages, you will find the latest information on the MIP program, AHA's advocacy efforts and educational activities, and links to CMS resources.

Click to view: Medicaid RACs: Are you Ready? Angela Brice-Smith, Director of the Medicaid Integrity Group, CMS Center for Program Integrity For AHA Members Only

Payment Audit and Recovery Programs: Navigating the Program Integrity Maze for Your Members State Issues Forum Meeting, January 19, 2011 FOR MEMBERS ONLY Agenda Presentations View from the Top Peter Budetti, MD, JD, Deputy Administrator & Director, CMS Center for Program Integrity Déjà Vu All Over Again - The Medicaid RAC Rollout  Angela Brice-Smith, Director of the Medicaid Integrity Group, CMS Center for Program Integrity Sorting Through the Maze - What Your Members Need to Know Sheree Kanner, Partner, Hogan Lovells  Getting Your Members Ready: What Have We Learned So Far?  Thornton Kirby, President/CEO, South Carolina Hospital Association Bo Ryall, President/CEO, Arkansas Hospital Association Recovery Audit Contractors as Whistleblowers: How Medicare and Medicaid Auditors Can Receive a "Double Kickback" From the Government as Qui Tam Plaintiffs,  BNA Health Law Reporter, 1/13/11 State Medicaid Integrity Program Activities, January 2011 (For State Association Executives Only)