MEDICAID PROGRAM INTEGRITY MANUAL CHAPTER …

MEDICAID PROGRAM INTEGRITY MANUAL CHAPTER 1 MEDICAID INTEGRITY PROGRAM (MIP) Table of Contents (Rev. 10384, Issued: 10-09-20) Transmittals for CHAPTER 1 Basis of Authority Statutory/Regulatory Citation Background Definitions State Collaboration Purpose Complaint and Lead Screening Vetting Process Investigation Review Process + Initiation of an Investigation Release of MEDICAID Data to UPIC Extrapolation Look Back Period Medical Review for PROGRAM INTEGRITY Purposes Request of Medical Records Review of Medical Records Completion of a Medical Records Review Overpayment Assessment Documentation of Investigation and Medical Review Findings Overpayment Resolution Process Calculation of FFP Based on State s Date of Expenditure State Appeal Process Close-Out Letters MEDICAID

The UPICs utilize a variety of techniques to address any potentially fraudulent, wasteful, or abusive billing practices based on the various leads they receive. The UPICs integrate the program integrity functions for audits and investigations across Medicare and

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