Medicaid Integrity Program

Since 2006, the Centers for Medicare & Medicaid Services’ Medicaid Integrity Program has been collaborating with states to promote best practices and awareness of Medicaid and Children’s Health Insurance Program (CHIP) fraud, waste, and abuse. Our oversight and educational work help preserve Medicaid dollars and support states as they serve the needs of Medicaid beneficiaries.

Update: July 22, 2020:

Pursuant to the Robert T. Stafford Disaster Relief and Emergency Assistance Act, President Trump declared on March 13, 2020, that, as a result of the effects of Coronavirus Disease 2019 (COVID-19), a national emergency exists nationwide, retroactive to March 1, 2020. On January 31, 2020, Secretary Azar of the Department of Health & Human Services (HHS) declared a nationwide public health emergency, retroactive to January 27, 2020.   

On April 2, 2020, CMS announced that it was exercising its enforcement discretion to adopt a temporary policy of relaxed enforcement for the Payment Error Rate Measurement (PERM) program. Accordingly, CMS suspended all improper payment-related engagement/communication or data requests to providers and state agencies, including calls and communications regarding existing PERM Corrective Action Plans (CAPs).

Effective July 22, 2020, CMS will restart PERM CAP-related engagements with states, as described below:

• Cycle 3 (Reporting Year (RY) 2018) CAPs: CMS will contact Cycle 3 states to schedule meetings to resume discussions of RY 2018 CAPs that were submitted to CMS in January. These discussions will include opportunities for Cycle 3 states to respond to questions previously sent to states in early April 2020. Instructions for the CAP presentation will be sent in advance of the meeting.
• Cycle 1 (RY 2019) CAPs: In the upcoming weeks, Cycle 1 states will receive follow-up correspondence regarding the CAPs that CMS received prior to the public health emergency. Cycle 1 states will be given an opportunity to address and respond to any questions and subsequently present their revised CAPs to CMS.

In addition to the specific communications outlined above, CMS will restart regular PERM CAP meetings with all relevant states, including the quarterly cohort calls, the CAP State Advisory Committee calls, and bi-monthly CAP follow-up calls to address CAP-related questions and issues. Please reach out to your CMS PERM CAP Point of Contact if you have any questions.

Oversight Activities

We undertake various oversight activities to ensure that Medicaid dollars are spent appropriately and accurately. For additional information, see our 5-year, Comprehensive Medicaid Integrity Plan (PDF) for FYs 2019-2023 to protect taxpayer dollars in the Medicaid program and CHIP by combatting fraud, waste, and abuse.

Educational Efforts

We provide a variety of educational resources online to help states, health plans, providers, and others in the fight against fraud, waste, and abuse. These resources cover important topics and best practices to support state program integrity staff. We also provide toolkits that explain Medicaid benefits that are prone to errors, such as non-emergency medical transportation, personal care services, and more.

Medicaid Integrity Institute

We provide training year-round to State Medicaid Program Integrity personnel through the Medicaid Integrity Institute.

Learn More

• Comprehensive Medicaid Integrity Plan for FYs 2019-2023 (PDF) – Read our detailed plan to protect taxpayer dollars in the Medicaid program and CHIP by combatting fraud, waste, and abuse.
• Annual Reports to Congress – Medicaid and Medicare Program Integrity Programs – Get a detailed understanding of how we use our funds and the effectiveness of our efforts in our annual reports to Congress.
• State Program Integrity Reviews – Learn from the experience of other states by reading our annual state and topical reviews.

Report Suspected Fraud, Waste, and Abuse

Medicaid fraud, waste, and abuse can happen at the provider, supplier, and beneficiary level. Because each state manages its own Medicaid program, you should contact your state to report suspicious activity. You can also learn how to report Medicare fraud, waste, or abuse.

Stay in Touch

Contact us by email with questions or suggestions at [email protected].