One of the responsibilities of CMS under the Medicaid Integrity Program is to:

Hiring contractors to audit Medicaid provider claims is a key responsibility of the Centers for Medicare & Medicaid Services (CMS) under the Medicaid Integrity Program. The program focuses on reducing improper payments and enhancing the integrity of the Medicaid program by ensuring that claims submitted for reimbursement are valid and compliant with federal and state regulations.

By engaging contractors specifically for the purpose of auditing provider claims, CMS aims to identify and prevent fraud, waste, and abuse within the Medicaid system. These contractors conduct thorough reviews of claims submitted by healthcare providers and may also perform audits to ensure that the services billed align with those provided and the documentation supports the claims made.

This proactive measure is intended to not only detect problems after they occur but also to deter providers from submitting improper claims in the first place. This role is important in maintaining the fiscal integrity of the Medicaid program, as it helps to protect government resources and ensure that Medicaid beneficiaries receive appropriate care.