All federal healthcare programs are required to implement programs to prevent and reduce provider fraud, waste, and abuse and this includes the Medicaid program. Two groups work in conjunction with the Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General (OIG):
the Medicaid Integrity Program (MIP) works at the federal level
the Medicaid Fraud Control Unit (MFCU) works on the state level
Both units are tasked with the responsibility to detect, investigate and prosecute those suspected of criminal violations within the Medicaid program.
Medicaid Integrity Contractor (MIC)
Working in conjunction with states they cover, Medicaid Integrity Contractors (MICs) conduct postpayment audits of all types of Medicaid providers and report identified overpayments to states for recovery. Audits can also include on-site visits. Some MICs have already been consolidated into UPICs (see below).
Unified Program Integrity Contractor (UPIC)
UPICs are a new review program developed by the Centers for Medicare & Medicaid Services (CMS) as part of their ongoing efforts to coordinate audits, investigations, and data analyses, and to lower the burden on providers. UPICs consolidate the Medicaid Integrity Contractors (MICs) and the Medicare Zone Program Integrity Contractors (ZPICs) into a single program administered by single contractors within multi-state jurisdictions.
See the References below for links to learn more about these programs.
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