Welcome to the Division of Program Integrity's webpage.
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.
For 2016, CMS will be hosting several Payment Error Rate Measurement (PERM) conference calls to providers for 2016. Please click on the Provider Call information to learn when the calls will be available.
Education and Training from CMS
The Centers for Medicare and Medicaid Services (CMS) Center for Program Integrity is now offering education and training on it's Medicaid Program Integrity (MPIE)page.
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.
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.
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.