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Program Integrity

New webpage for the KY Medicaid Terminated and Excluded Provider List.

June 25, 2013 - The Kentucky Department for Medicaid Services maintains a list of providers whose Medicaid provider agreement has either been terminated or the provider has been placed on an exclusion list. To view this view, either click on the Medicaid Terminated and Excluded Provider List located on the left or click here.

Upcoming workshop

The next Centers for Medicare and Medicaid Services (CMS) Payment Error Rate Measurement (PERM) conference call will occur on July 17, 2013. For information about this call, click here.

Policy Update
DMS does not provide guidance on billing

The Department for Medicaid Services does not provide guidance on how companies should bill for services, but will direct you to applicable regulations.

If you receive direction from staff about how to bill, the Department will not be bound by such instruction, unless it was given by a Director or Commissioner.

Announcement

To better monitor the prescriptions and care of Medicaid members, the Kentucky Department for Medicaid Services (DMS) will require all prescribing providers to enroll with DMS as credentialed practitioners. DMS will begin outreach to non-enrolled prescribers to assist with the enrollment process. Effective Sept. 1, 2010, DMS will no longer add non-Medicaid prescribers to its files. Effective Oct. 1, 2010, there will be no reimbursement for prescriptions by non-Medicaid providers, which will result in prescriptions denying. Please notify your patients that if they accept a prescription from a non-Medicaid provider, DMS will not pay for the prescription. For information about enrollment and to download an application (MAP 811) please visit our website.

If you have any questions or need assistance in completing the enrollment documentation, please contact the Provider Services Branch at 877-838-5085 Monday-Friday 10 a.m. to 4:30 p.m.

Announcement

Health Integrity Awarded Contracts to Identify Medicaid Overpayments

Health Integrity has been awarded two contracts by the Centers for Medicare and Medicaid Services (CMS) to serve as an audit Medicaid integrity contractor (Audit MIC). For more information, refer to the news release.

Attention Providers: Medicaid Partnering with Revenue for Tax Intercept

Effective May 15, 2010, the Department for Medicaid Services and the Department of Revenue have combined efforts to collect on outstanding debts due to any Commonwealth of Kentucky State agency.

To learn more how this may affect you, refer to the Revenue Tax Intercept Letter.

The Program Integrity Division is responsible for

  • Guarding against fraud, abuse and deliberate misuse of Medicaid program benefits by individual providers and recipients;
  • Ensuring that Medicaid recipients receive necessary medical care at a level of quality consistent with that available to the general population;
  • Assuring provider and recipient compliance with federal and state Medicaid rules and regulations;

The Program Integrity Division accomplishes this by working with the following functions:

Fraud and Abuse - Plans, develops and directs Agency efforts to identify, prevent and prosecute fraud, abuse and/or misuse in the Medicaid program. This includes verifying that medical services are appropriate and rendered as billed, that services are provided by qualified providers to eligible recipients, that payments for those services are correct and that all funds identified for collection are pursued

Provider Enrollment - Enrolls and updates information for new and existing KY Medicaid providers.

Third Party Liability - Identifies Medicaid recipients who have other medical insurance to ensure Medicaid is payor of last resort.

 

Laws and Medicaid Integrity Program (MIP) Information
 

Code of Federal Regulations (CFR)
42 CFR 455

Kentucky Administrative Regulations (KAR)
907 KAR 1:675

Medicaid Integrity Program (MIP) Information

 

Contact Information
 

For policy questions regarding Fraud and Abuse, contact

Division of Program Integrity
275 East Main Street, 6EA
Frankfort, KY 40601

Phone: (502) 564-5472

To report Fraud or Abuse, contact

Cabinet for Health and Family Services
Office of the Inspector General
Division of Special Investigations
275 East Main Street, 5 E-D
Frankfort, Kentucky 40621

Toll Free: (800) 372-2970

 

Last Updated 9/30/2014
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