Question

What is a Medicaid Integrity Plan? Who is responsible for creating and maintaining it? What does it cover?

Answer 1

The Medicaid Integrity Plan has two broad responsibilities;

Hiring the contractors for reviewing the Medicaid provider activities such as; audit claims, identify overpayments, and educating the providers and others on Medicaid program integrity issues

Providing effective support and assistance to States in their efforts of combating Medicaid provider; fraud and abuse.

Under the provisions of the Deficit Reduction Act (DRA) of 2005, the Congress directed CMS for establishing the Medicaid Integrity by consulting with key stakeholders. For this, the section 1936(d) of the Social Security Act was used to direct the Secretary of Health and Human Services for establishing a comprehensive plan for ensuring the integrity of the Medicaid program. This program of Medicaid Integrity covers the combating of fraud, waste, and abuse.