The purpose of the Program Integrity Division is:

1. (1) To guard against fraud, waste, and/or abuse of Medicaid program benefits by individual providers and recipients;
2. (2) To assure that Medicaid recipients receive necessary medical care at a level of quality consistent with that available to general population;
3. (3) To exercise necessary fiscal control over federal and state tax dollars;
4. (4) To assure provider and recipient compliance with federal and state Medicaid rules and regulations; and
5. (5) To assist in the identification of claims processing procedures that may be in conflict with State policy.

Author: Jacqueline G. Thomas, Director, Program Integrity Division

Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §§431, 455, 456, 1000, 1001, 1002; State Medical Manual 11420.6M.

History: Rule effective October 1, 1982. Amended: effective November 10, 1988. Repealed and Replaced: Filed February 7, 1994; effective March 15, 1994. Amended: Filed September 11, 2018; effective October 26, 2018.