State Program Integrity Reviews

Medicaid and the Children's Health Insurance Program (CHIP) are required to have a fraud detection and investigation program that meets certain federal standards. To assist the states with these requirements, CMS offers the Medicaid Program Integrity Manual.
To help oversee this requirement, CMS conducts focused program integrity reviews on high-risk areas in the Medicaid program:

Case tracking and referrals
Managed care
New statutory and regulatory compliance
Overpayment identification and recovery
Personal Care Services
Pre-payment and post-payment review
Surveillance and utilization systems
Territory oversight operations

As a companion to the comprehensive reviews, CMS created Frequent Findings reports. These toolkits were designed to help states better understand requirements and improve compliance with regulations for provider disclosures, federal database checks, and reporting adverse actions taken against providers to HHS-OIG.

Beginning in 2014, CMS began conducting focused reviews. Focused reviews are conducted to determine the extent of program integrity (PI) oversight of the Medicaid program by the States. Traditionally, these reviews have focused on high risk areas of managed care, Affordable Care Act provisions, personal care services and non-emergency medical transportation.

These reviews are designed to identify risks and vulnerabilities to the Medicaid program and assist states with strengthening program integrity operations. The significance and value of performing onsite program integrity reviews include:

Assess the effectiveness of the state’s PI efforts, including compliance with certain Federal statutory and regulatory requirements
Identify risks and vulnerabilities to the Medicaid program and assist states to strengthen PI operations
Help inform CMS in developing future guidance to states
Help prepare states with the tools to improve PI operations and performance

Annual Summary Reports

Search below for comprehensive and focused reports by state or year.

State / Territory	Fiscal Year	Date of Report	Focus Area
State / Territory Tennessee	Fiscal Year 2015	Date of Report 2015-12-31	Focus Area Focused: Managed Care
State / Territory Delaware	Fiscal Year 2015	Date of Report 2016-02-16	Focus Area Focused: Managed Care
State / Territory Nevada	Fiscal Year 2015	Date of Report 2016-03-01	Focus Area Focused: Managed Care
State / Territory Pennsylvania	Fiscal Year 2015	Date of Report 2016-03-01	Focus Area Focused: Managed Care
State / Territory North Carolina	Fiscal Year 2015	Date of Report 2016-05-03	Focus Area Focused: Managed Care
State / Territory Missouri	Fiscal Year 2015	Date of Report 2016-05-03	Focus Area Focused: Managed Care
State / Territory Connecticut	Fiscal Year 2015	Date of Report 2016-05-03	Focus Area Focused: Personal Care Services
State / Territory Wisconsin	Fiscal Year 2015	Date of Report 2016-07-05	Focus Area Focused: Managed Care
State / Territory Puerto Rico	Fiscal Year 2016	Date of Report 2016-08-02	Focus Area Focused: Managed Care
State / Territory Vermont	Fiscal Year 2015	Date of Report 2016-10-04	Focus Area Focused: Managed Care
State / Territory Texas	Fiscal Year 2015	Date of Report 2016-12-01	Focus Area Focused: Managed Care
State / Territory Virginia	Fiscal Year 2016	Date of Report 2017-02-01	Focus Area Focused: Managed Care
State / Territory Maryland	Fiscal Year 2016	Date of Report 2017-03-07	Focus Area Focused: Managed Care
State / Territory Kentucky	Fiscal Year 2016	Date of Report 2017-05-01	Focus Area Focused: Managed Care
State / Territory New Hampshire	Fiscal Year 2016	Date of Report 2017-05-31	Focus Area Focused: Managed Care
State / Territory South Carolina	Fiscal Year 2016	Date of Report 2017-06-01	Focus Area Focused: Managed Care
State / Territory Utah	Fiscal Year 2016	Date of Report 2017-06-01	Focus Area Focused: Managed Care
State / Territory Rhode Island	Fiscal Year 2016	Date of Report 2017-06-01	Focus Area Focused: Managed Care
State / Territory Nebraska	Fiscal Year 2016	Date of Report 2017-06-01	Focus Area Focused: Managed Care
State / Territory West Virginia	Fiscal Year 2016	Date of Report 2017-06-01	Focus Area Focused: Managed Care
State / Territory Arizona	Fiscal Year 2017	Date of Report 2017-07-28	Focus Area Focused: Managed Care
State / Territory Alabama	Fiscal Year 2016	Date of Report 2017-07-28	Focus Area Focused: Managed Care
State / Territory District of Columbia	Fiscal Year 2017	Date of Report 2017-08-01	Focus Area Focused: Managed Care
State / Territory Louisiana	Fiscal Year 2017	Date of Report 2017-08-01	Focus Area Focused: Managed Care
State / Territory Colorado	Fiscal Year 2017	Date of Report 2017-10-02	Focus Area Focused: Managed Care
State / Territory Indiana	Fiscal Year 2017	Date of Report 2017-11-01	Focus Area Focused: Managed Care
State / Territory Iowa	Fiscal Year 2017	Date of Report 2018-01-01	Focus Area Focused: Personal Care Services
State / Territory Florida	Fiscal Year 2017	Date of Report 2018-01-03	Focus Area Focused: Managed Care
State / Territory South Dakota	Fiscal Year 2017	Date of Report 2018-02-01	Focus Area Focused: Personal Care Services
State / Territory Mississippi	Fiscal Year 2017	Date of Report 2018-03-30	Focus Area Focused: Managed Care
State / Territory New York	Fiscal Year 2017	Date of Report 2018-04-30	Focus Area Focused: Personal Care Services
State / Territory Oregon	Fiscal Year 2018	Date of Report 2018-11-01	Focus Area Focused: Managed Care
State / Territory Georgia	Fiscal Year 2018	Date of Report 2018-11-30	Focus Area Focused: Managed Care
State / Territory Arkansas	Fiscal Year 2018	Date of Report 2018-12-03	Focus Area Focused: Personal Care Services
State / Territory Wyoming	Fiscal Year 2018	Date of Report 2018-12-03	Focus Area Focused: Personal Care Services
State / Territory Kansas	Fiscal Year 2018	Date of Report 2019-01-01	Focus Area Focused: Managed Care
State / Territory Washington	Fiscal Year 2018	Date of Report 2019-01-04	Focus Area Focused: Managed Care
State / Territory Idaho	Fiscal Year 2018	Date of Report 2019-01-08	Focus Area Focused: Managed Care
State / Territory Illinois	Fiscal Year 2018	Date of Report 2019-01-08	Focus Area Focused: Managed Care
State / Territory Minnesota	Fiscal Year 2018	Date of Report 2019-01-09	Focus Area Focused: Personal Care Services
State / Territory Delaware	Fiscal Year 2018	Date of Report 2019-01-31	Focus Area Focused: Personal Care Services
State / Territory Oklahoma	Fiscal Year 2018	Date of Report 2019-01-31	Focus Area Focused: Personal Care Services
State / Territory Texas	Fiscal Year 2018	Date of Report 2019-01-31	Focus Area Focused: Personal Care Services
State / Territory North Dakota	Fiscal Year 2019	Date of Report 2019-07-01	Focus Area Focused: Personal Care Services
State / Territory Tennessee	Fiscal Year 2019	Date of Report 2019-07-01	Focus Area Focused: Personal Care Services
State / Territory Ohio	Fiscal Year 2019	Date of Report 2019-10-01	Focus Area Focused: Managed Care
State / Territory Connecticut	Fiscal Year 2019	Date of Report 2019-10-31	Focus Area Focused: Personal Care Services
State / Territory Maine	Fiscal Year 2019	Date of Report 2019-11-01	Focus Area Focused: Personal Care Services
State / Territory Massachusetts	Fiscal Year 2019	Date of Report 2020-02-01	Focus Area Focused: Managed Care
State / Territory Pennsylvania	Fiscal Year 2019	Date of Report 2020-02-01	Focus Area Focused: Managed Care
State / Territory Montana	Fiscal Year 2019	Date of Report 2020-02-01	Focus Area Focused: Personal Care Services
State / Territory New Jersey	Fiscal Year 2019	Date of Report 2020-03-01	Focus Area Focused: Managed Care
State / Territory Vermont	Fiscal Year 2019	Date of Report 2020-03-01	Focus Area Focused: Managed Care
State / Territory Missouri	Fiscal Year 2019	Date of Report 2020-03-02	Focus Area Focused: Managed Care
State / Territory New Mexico	Fiscal Year 2019	Date of Report 2020-03-02	Focus Area Focused: Managed Care
State / Territory New Jersey	Fiscal Year 2019	Date of Report 2020-03-02	Focus Area Focused: Managed Care
State / Territory Alabama	Fiscal Year 2021	Date of Report 2021-12-01	Focus Area Focused: Personal Care Services
State / Territory Iowa	Fiscal Year 2021	Date of Report 2022-01-01	Focus Area Focused: Managed Care
State / Territory West Virginia	Fiscal Year 2021	Date of Report 2022-02-01	Focus Area Focused: Personal Care Services
State / Territory Rhode Island	Fiscal Year 2021	Date of Report 2022-04-01	Focus Area Focused: Managed Care
State / Territory Kentucky	Fiscal Year 2021	Date of Report 2022-05-01	Focus Area Focused: Managed Care
State / Territory Wisconsin	Fiscal Year 2021	Date of Report 2022-05-01	Focus Area Focused: Managed Care
State / Territory Michigan	Fiscal Year 2021	Date of Report 2022-06-01	Focus Area Focused: Managed Care
State / Territory Utah	Fiscal Year 2021	Date of Report 2022-06-01	Focus Area Focused: Managed Care
State / Territory Maryland	Fiscal Year 2021	Date of Report 2022-10-17	Focus Area Focused: Managed Care
State / Territory Nevada	Fiscal Year 2021	Date of Report 2022-10-17	Focus Area Focused: Managed Care
State / Territory Virginia	Fiscal Year 2021	Date of Report 2022-10-17	Focus Area Focused: Managed Care
State / Territory South Carolina	Fiscal Year 2021	Date of Report 2022-10-18	Focus Area Focused: Managed Care
State / Territory Nebraska	Fiscal Year 2022	Date of Report 2023-04-03	Focus Area Focused: Managed Care
State / Territory Hawaii	Fiscal Year 2022	Date of Report 2023-04-05	Focus Area Focused: Managed Care
State / Territory Arizona	Fiscal Year 2022	Date of Report 2023-05-17	Focus Area Focused: Managed Care
State / Territory Colorado	Fiscal Year 2022	Date of Report 2023-05-17	Focus Area Focused: Managed Care
State / Territory Mississippi	Fiscal Year 2022	Date of Report 2023-06-01	Focus Area Focused: Managed Care
State / Territory New Hampshire	Fiscal Year 2022	Date of Report 2023-06-01	Focus Area Focused: Managed Care
State / Territory District of Columbia	Fiscal Year 2022	Date of Report 2023-08-01	Focus Area Focused: Managed Care
State / Territory California	Fiscal Year 2022	Date of Report 2023-09-01	Focus Area Focused: Managed Care
State / Territory Indiana	Fiscal Year 2022	Date of Report 2023-10-10	Focus Area Focused: Managed Care
State / Territory Louisiana	Fiscal Year 2022	Date of Report 2023-10-10	Focus Area Focused: Managed Care
State / Territory South Dakota	Fiscal Year 2022	Date of Report 2023-10-10	Focus Area Focused: Personal Care Services
State / Territory Alaska	Fiscal Year 2022	Date of Report 2024-02-08	Focus Area Comprehensive
State / Territory North Carolina	Fiscal Year 2022	Date of Report 2024-03-13	Focus Area Focused: Personal Care Services
State / Territory Washington	Fiscal Year 2023	Date of Report 2024-05-29	Focus Area Focused: Managed Care
State / Territory Illinois	Fiscal Year 2023	Date of Report 2024-07-01	Focus Area Focused: Managed Care
State / Territory Minnesota	Fiscal Year 2023	Date of Report 2024-10-16	Focus Area Focused: Managed Care
State / Territory Wyoming	Fiscal Year 2023	Date of Report 2024-12-12	Focus Area Focused: Personal Care Services

Page Last Modified:

11/20/2024 11:13 AM

Help with File Formats and Plug-Ins

CMS Newsroom

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3

section title h3