Medicaid Integrity Program

Medicaid Integrity Program

Since 2006, the Centers for Medicare & Medicaid Services’ (CMS) Medicaid Integrity Program has collaborated with states to promote best practices and awareness of Medicaid and Children’s Health Insurance Program (CHIP) fraud, waste, and abuse. Our oversight and educational work help preserve Medicaid dollars and support states as they serve the needs of Medicaid beneficiaries.

Oversight Activities

We undertake various oversight activities to ensure that Medicaid dollars are spent appropriately and accurately. For additional information, see our 5-year, Comprehensive Medicaid Integrity Plan (PDF) for FYs 2024-2028 to protect taxpayer dollars in the Medicaid program and CHIP by combatting fraud, waste, and abuse.

Educational Efforts

CMS provides a variety of educational resources to help states, health plans, providers, and others combat Medicaid fraud, waste, and abuse. These resources cover important topics and best practices to support state program integrity staff. CMS also provides toolkits that explain Medicaid benefits that are prone to errors, such as non-emergency medical transportation, personal care services, and more.

Medicaid Integrity Institute

CMS provides training year-round to state Medicaid program integrity personnel through the Medicaid Integrity Institute.

Resources

• Comprehensive Medicaid Integrity Plan for FYs 2024-2028 (PDF) – CMS’ detailed plan to protect taxpayer dollars in the Medicaid program and CHIP by combatting fraud, waste, and abuse.
• Annual Reports to Congress – Medicaid and Medicare Program Integrity Programs – Describes how CMS’ uses funds and the effectiveness of efforts to combat fraud, waste, and abuse in Medicare, Medicaid, and Marketplace.
• State Program Integrity Reviews – CMS conducts reviews of state’s program integrity efforts in the Medicaid program.

Report Suspected Fraud, Waste, and Abuse

Medicaid fraud, waste, and abuse can happen at the provider, supplier, and beneficiary level. Because each state manages its own Medicaid program, you should contact your state to report suspicious activity. You can also learn how to report Medicare fraud, waste, or abuse.

Stay in Touch

Contact us by email with questions or suggestions at Medicaid_Integrity_Program@cms.hhs.gov.