The Centers for Medicare & Medicaid Services (CMS) is committed to combating Medicaid provider fraud, waste, and abuse which diverts dollars that could otherwise be spent to safeguard the health and welfare of Medicaid recipients.  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. (For Medicaid Program - General Information, click on the "Related Links Inside CMS" below.)

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

Along with these responsibilities, section 1936 of the Act requires that CMS develop a five-year Comprehensive Medicaid Integrity Plan (CMIP) in consultation with internal and external partners.  The first CMIP, covering FYs 2006-2010, was published in July 2006. (For Comprehensive Medicaid Integrity Plan (CMIP), click on the "Related Links Inside CMS" below.) 

CMS is also required to report to Congress annually on the effectiveness of the use of funds appropriated for the MIP. (For Report to Congress, click on the "Related Links Inside CMS" below.)

Although the States are primarily responsible for combating 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.  Therefore, additional sections of this Web site include:

How to Report Fraud: provides information on how to report cases of suspected Medicaid fraud to the appropriate agencies.  (Click on "Related Links Inside CMS" below.)

State Program Integrity Support & Assistance: provides information on the technical assistance, guidance, training and other support to States to assist in their efforts to combat Medicaid fraud, waste, and abuse.  (Click on "Related Links Inside CMS" below.)

Other information and resources on Medicaid program integrity can be found in the Related Links below.

Deficit Reduction Act (DRA) of 2005: provides information on the DRA, the legislation which created the MIP.

State Contacts: provides contact information for State program integrity officials.  After clicking on State Contacts, choose the respective State/Territory.  For Contact Type, choose "All Contact Types," and for Organization Type, choose "State Medical Assistance Office."  Then, click on the "Show Contacts" button.  When you reach the office, ask for the Medicaid Program Integrity contact. 

Medicare Fraud - How to Report: provides instructions on how to report suspected cases of Medicare fraud to the appropriate agencies.

Office of Inspector General (OIG) - Fraud Prevention and Detection: links to the HHS-OIG Fraud Prevention and Detection Web site.  

Downloads
There are no Downloads
Related Links Inside CMS
Medicaid Program - General Information Comprehensive Medicaid Integrity Plan (CMIP) Report to Congress How to Report Fraud State Program Integrity Support & Assistance Deficit Reduction Act (DRA) of 2005 State Contacts Medicare Fraud - How to Report
Related Links Outside CMS
OIG - Fraud Prevention and Detection

Page Last Modified: 07/22/2009 3:43:11 PM
Help with File Formats and Plug-Ins