Medicaid Integrity Provider Education Program - View provider education materials that promote best practices across five therapeutic drug classes that have been identified as having high potential for improper payment.

Frequently Asked Questions (FAQs) on the Medicaid RAC Program - FAQs address questions about various operational aspects of the implementation of state Medicaid RACs. It serves as guidance on such topics as appeals, contingency fees, and State reporting.

CMS Program Integrity Initiatives – Center for Program Integrity (CPI) - Provides an overview of CMS' CPI including CPI's mission, vision, organization and strategic direction. The article also outlines CPI's key anti-fraud activities in the areas of prevention, detection, transparency and accountability, recovery and CPI's future direction.

Medicaid Integrity Manual (MIM) - The MIM promotes continuity and consistency of the MIP by providing a comprehensive guide to its overall operations. It serves as a reference tool to assist State Medicaid programs, providers, health care organizations, and other stakeholders.

Drug Diversion in the Medicaid Program (National Bulletin, Revised January 2012) - View examples of strategies which States have pursued to pro-actively combat this problem as well as examples of legislation designed to help contain it.

FY 2010 Medicaid Integrity Program Report to Congress (RTC) -  This report fulfills CMS' statutory requirement to summarize the use of funds appropriated under the Deficit Reduction Act of 2005 for the MIP.  The RTC, in summarizing the MIP, not only informs Congress of the work performed by CMS in curbing fraud, waste, and abuse, but also reflects the contribution each state's Medicaid program integrity function makes to ensure our nation's health care system remains viable and trustworthy.

2011 Program Integrity Review Annual Summary Report - This is a compendium of data collected from state comprehensive program integrity reviews (FYs 2009 and 2010) for which final reports were issued. The report includes information about best practices, areas of vulnerability, and areas of non-compliance.

CMS Center for Program Integrity (CPI) – Center for Medicaid, CHIP and Survey & Certification (CMCS) Bulletin CPI-B 11-05 - 5/31/2011 - Provides guidance to States regarding implementation of Affordable Care Act Section 6501 - Termination of Provider Participation under Medicaid if Terminated under Medicare or other State Plan.

Open Door Forum Transcript - 11/3/2010 – Provides an update on the MIP's activities from the last 12 months, as well as, a perspective of how the national Medicaid audit program is evolving including some policy changes that have been implemented.

Medicaid Recovery Audit Contractors (RAC) At-A-Glance - This map shows the status of each Medicaid program's State Plan amendment for the RAC program, and it is updated on an ongoing basis.

CMS Center for Program Integrity (CPI) – Center for Medicaid, CHIP and Survey & Certification (CMCS) Bulletin CPI-B 11-03 - 2/1/2011 - This bulletin issued to State Medicaid Directors and State Program Integrity Directors provides information on delaying State implementation of their RAC programs until the new implementation date is indicated in the Final Rule. CMS anticipates issuing the Final Rule later this year.

Proposed Rule CMS-6034-P – Medicaid Program; Recovery Audit Contractors (RACs) - This proposed rule would provide guidance to States related to Federal/State funding of State start-up, operation, and maintenance costs of Medicaid RACs and the payment methodology for State payments to Medicaid RACs in accordance with section 6411 of the Affordable Care Act. In addition, this rule proposes requirements for States to assure that adequate appeal processes are in place for providers to dispute adverse determinations made by Medicaid RACs. Finally, the rule proposes that States and Medicaid RACs coordinate with other contractors and entities auditing Medicaid providers and with State and Federal law enforcement agencies. 

Provider Audit Frequently Asked Questions (FAQs) - Provider Audit FAQs are posted on the CMS Web site. 

Audit Medicaid Integrity Contractors (MIC) Statement of Work - provides the Request for Proposal that the Centers for Medicare & Medicaid Services released when soliciting the work for the Audit MICs. You can find a copy of the Statement of Work which outlines the basic requirements the Audit MICs are under contract to perform.

CMS Center for Program Integrity (CPI) Bulletin CPI-B 10-02 - 9/29/2010 - This was recently issued to the State Program Integrity Directors.  The bulletin provides key information about two policies that the CMS Audit Medicaid Integrity Contractors will be following beginning October 1, 2010.