Medicaid Integrity Program

Audits Underway in Texas

The Medicaid Integrity Program, established by the Deficit Reduction Act of 2005, directs the secretary of the U.S. Department of Health and Human Services to establish a comprehensive plan to combat fraud, waste and abuse in the Medicaid program. The primary focus of the audit is to review actions of providers furnishing services under the Texas Medicaid program, and to audit the claims paid for the items or services rendered.

The Centers for Medicare & Medicaid Services is responsible for implementing the program, along with the Texas Health and Human Services Commission. The audit contractor for Texas is Health Management Systems. In March 2009, hospitals began receiving Medicaid Integrity Audit notification letters from HMS.

The following contacts/resources may be helpful for Texas hospitals.

Contacts

Texas Health and Human Services Commission - Internal Audit Division
E-mail: CMS-MIGProgramAudits@hhsc.state.tx.us
Centers for Medicare and Medicaid Services – Medicaid Integrity
E-mail: Medicaid_Integrity_Program@cms.hhs.gov
Health Management Systems - contact for issues, concerns, questions or extension request regarding desk or field audits:
- Cyprain (C.Y.) Ihekwoaba, HMS Audit Project Manager, 5615 High Point Drive, Suite 100, Irving, TX 75038 or e-mail cihekwoaba@hms.com

Resources

Frequently asked questions (PDF)
Audit schedule (PDF)
Review schedule by state (PDF)
Medicaid Integrity Program A to Z (PDF)
(a background document detailing all of the steps included in the audit process)
Medicaid Integrity Program Meeting Transcript (PDF)
(a transcript of the CMS open door forum conference call held in July 2009)
Letter to state Medicaid directors re: provider exclusions (PDF)
PowerPoint presentation from HMS (PPT)

Additional audit updates are available on the CMS Web site.