U S Department of Health and Human Services www.hhs.gov
  CMS Home > Medicaid > Medicaid Fraud & Abuse - General Information > Overview

Medicaid Fraud & Abuse - General Information


This site is intended to provide information and materials of interest to both consumers and professionals about Medicaid fraud and abuse. The Centers for Medicare & Medicaid Services (CMS) is committed to fighting fraud and abuse, which divert dollars that could otherwise be spent to safeguard the health and welfare of Medicaid clients.

To strengthen its commitment, CMS has implemented a Medicaid Integrity component.  This is in response to the provisions of the Deficit Reduction Act (DRA) of 2005, signed on February 8, 2006 by the President, in which Congress directed CMS to establish the Medicaid Integrity Program (MIP).  In doing so, it dramatically increased the resources available to CMS to combat fraud, waste and abuse in the Medicaid program.  The DRA provides that a five-year Comprehensive Medicaid Integrity Plan (CMIP) be written to guide MIP development and operations.  This CMIP specifically discusses statutory requirements, program philosophy, implementation, strategic efforts, and organizational structure. While the DRA requires that the CMIP be revised in five-year cycles, CMS will review and update the plan annually.   (For Comprehensive Medicaid Integrity Plan (CMIP), click on the "Related Links Inside CMS.")

Additionally, CMS is required to report to Congress annually on the use and effectiveness of the funds appropriated for the Medicaid Integrity Program (MIP). (For Report to Congress, click on the "Related Links Inside CMS.)

Although the states are primarily responsible for policing fraud in the Medicaid program, CMS provides technical assistance, guidance and oversight in these efforts. Fraud schemes often cross state lines, and CMS strives to improve information sharing among the Medicaid programs and other stakeholders.

Medicaid is the largest source of funding for medical and health-related services for people with limited income.  The average number of Medicaid enrollees in 2003 was estimated to be about 41.9 million, the largest group being children (19.3 million or 46 percent).  In 2001, 12.5 percent of the population was enrolled in the Medicaid program.

More than 46 million people received health care services through the Medicaid program in FY 2001 (the last year for which beneficiary data are available). In FY 2003, total outlays for the Medicaid program (Federal and State) were $278.3 billion, including:

  • Direct payments to providers of $197.3 billion,
  • Payments for various premiums (for HMOs, Medicare, etc.) of $52.1 billion,
  • Payments to disproportionate share hospitals of $12.9 billion, and
  • Administrative costs of $16.0 billion.
  • Outlays under the SCHIP program in FY 2003 were $6.1 billion. With no changes to either program, expenditures under Medicaid and SCHIP are projected to reach $445 billion and $7.5 billion, respectively, by FY 2009.

The related links below will provide you with technical assistance and guidance to support you in your ongoing effort to fight against fraud and abuse: State Contacts and Medicaid Guidance and Reports.  After clicking on State Contacts, choose the respective State/Territory and click the Show Contacts button.  When you reach the office,  ask for the Medicaid Program Integrity Contact.  Additional assistance can be found at the related links below: Medicare Fraud - How to Report and the Office of Inspector General (OIG) - Fraud Prevention and Detection.

There are no Downloads
Related Links Inside CMS
Comprehensive Medicaid Integrity Plan (CMIP)

Report to Congress

State Contacts

Medicaid Guidance Fraud Prevention

Medicaid Reports Fraud Prevention

Medicare Fraud - How to Report
Related Links Outside CMSExternal Linking Policy
OIG - Fraud Prevention and Detection


Page Last Modified: 11/19/2008 5:08:24 PM
Help with File Formats and Plug-Ins

Submit Feedback