• Home
• Corporate Governance and Compliance
• Sanction Screening
• Policies and Procedures
• Risk Management
• Program Integrity
• Physician Arrangements

Centers for Medicare & Medicaid Services

• CMS overview
• Recovery Audit Contractors
• Medicare Administrative Contractors
• Zone Program Integrity Contractors
• Medicaid Integrity Contractors
• Medicare Administrative Contractors

State Initiatives

• Overview
• Office of Medicaid Inspector General
• Medicaid Fraud Control Unit

Preparing for CMS contractors

• Committee
• Risk Assessment
• Policies and Procedures
• Education

Responding to CMS contractors

• Appeals Process
• Remediation Process

Office of Inspector General

• Work Plan
• Reports
• Fraud Prevention & Detection

Federal Register

 

Federal Sentencing Guidelines

welcome to Program Integrity Module

The healthcare industry is facing a new wave of government regulation. Both Federal and State government entities have programs and contractors in place focusing on the identification and recoupment of funds from improper payments. In addition to recovering funds, Federal and State entities are investigating and prosecuting cases of fraud and abuse, resulting in fines, exclusion from Federal healthcare programs, and prosecution.

The Program Integrity Module is your guide to the government programs and contractors that are at the heart of the enforcement environment. Find out who they are, what they are looking for, how to prepare for a review, and what to do during and after a review.