Medicaid integrity program: what you need to know

Over the last few years, Congress has established more programs for increased Medicaid enforcement activities. One of the earliest of these is the Medicaid Integrity Program, a federal program that was established in 2005 to cause uniform and consistent Medicaid enforcement activities across all states. Since that time, the Centers for Medicare & Medicaid Services (CMS) has been slowly implementing this program. Although it is based within CMS's framework, the vast majority of the work will be done by subcontractors, similar to the Medicare Recovery Audit Contractor program. The actual roll out of this program has been slow, but it is expected that enforcement activities will increase over the next 6 to 12 months.