Medicaid Toolkit

Medicaid Integrity Program

Fraud, waste, and abuse impact the health and well-being of Medicaid recipients. The Deficit Reduction Act (DRA) of 2005 created the Medicaid Integrity Program (MIP) under Section 1936 of the Social Security 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.

The Centers for Medicare & Medicaid Services (CMS) has three broad responsibilities under the MIP:

  • to hire contractors to review Medicaid provider activities, audit claims, identify overpayments, and educate providers and others about Medicaid program integrity issues;
  • to provide effective support and assistance to states in their efforts to combat Medicaid provider fraud and abuse;
  • to eliminate and recover improper payments in accordance with the Improper Payments Information Act of 2002.

Medicaid is primarily a state-run program to identify and combat fraud and abuse. CMS provides assistance and oversight in these determinations in order to facilitate the sharing of information between Medicaid shareholders.

Considerations

Audiologists and speech-language pathologists should be aware of activities stemming from the Comprehensive Medicaid Integrity Plan (CMIP), a 5-year strategy for combating fraud, waste, and abuse. The current CMIP can be found on the CMS website.

Resources

ASHA Corporate Partners