Medicaid Integrity Program (MIP)

In February 2006, the Medicaid Integrity Program (MIP) was established as one strategy of a legislative package that is intended to reduce the national deficit. MIP is a public auditor under the Centers for Medicare and Medicaid Services (CMS) which serves the main purpose of fighting fraud, waste, and abuse in the Medicaid program. Any provider may be audited, including, but not limited to, fee-for-service providers, institutional and non-institutional, as well as managed care entities. Audit Medicaid Integrity Contractors (Audit MICs) have been contracted to complete audits of Medicaid providers at the direction of CMS with the aim of recognizing overpayments and minimizing payments of improper claims.

The Audit MIC in Virginia is Health Integrity and they have already completed audits of many providers in the state. Services have been scrutinized due to lack of provider signatures, incomplete medical records, lack of medical necessity documented, and other common billing errors.

Resources

CMS Medicaid Integrity Program (cms.hhs.gov)

Medicaid Integrity Program A to Z (cms.gov)

Medicaid Integrity Program Provider Audits (cms.gov)

MIC Contract Overview (healthintegrity.org)

Medicaid Fraud (vaag.com)