CMS Medicaid Integrity Group Provider Audits

The Medicaid Integrity Group (MIG) of CMS is required to review Medicaid provider actions, audit claims, and identify over payments. CMS has contracted with Health Integrity, LLC, to conduct audits of providers enrolled with the Nebraska Medical Assistance Program. Beginning in January of 2010, Health Integrity, LLC, will begin auditing providers. The review will include record requests, entrance and exit conferences, and will be an onsite field audit, a desk audit, a comprehensive audit, or a cost report audit. The CMS MIG audits apply to any provider or entity that receives Medicaid money. This includes, but is not limited to hospitals, physicians, nursing homes, therapists (speech, physical, mental health, etc.), developmental disability programs, personal assistance, and chore providers. These audits are different from audits performed by Nebraska Medical Assistance Program staff and the CMS Payment Error Rate Measurement (PERM) Audit. The audits may lead to refund requests, provider sanctions, or referral to law enforcement for Medicaid fraud. The State of Nebraska must refund all federal money identified as paid in error.

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