Medicaid Integrity Program

The Medicaid Integrity Program was created to combat fraud, waste and abuse in the Medicaid program. Information and other resources are available to help hospitals prepare for audits and other reviews. The primary focus of the program is to review actions of Medicaid providers and 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.

Alerts None at this time.   Legislation None at this time.   Education None at this time.

Resources Frequently asked questions Review schedule by state Medicaid Integrity Program A to Z - a background document detailing the audit process Medicaid Integrity Program Meeting Transcript - a transcript of the CMS open door forum conference call held in July 2009 Letter to state Medicaid directors re: provider exclusions PowerPoint presentation from HMS Additional audit updates are available on the CMS Web site.