Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth
	MassHealth
	All Provider Bulletin 200
	January 2010




	TO:	All Providers Participating in MassHealth
	FROM:	Terence G. Dougherty, Medicaid Director

	RE:	Federal Medicaid Integrity Program Provider Audits


Important Information for All Providers
	The Centers for Medicare & Medicaid Services (CMS) has launched a 
	national program under which federal contractors, called Audit Medicaid 
Integrity Contractors (Audit MICs), will perform field and desk audits in 
order to identify any overpayments. IPRO has been awarded an Audit 
MIC contract to conduct audits in Massachusetts, beginning in January 
2010, and continuing through the next five years. 


Background	
The Deficit Reduction Act of 2005 created the Medicaid Integrity Program 
and directed CMS to enter into contracts with businesses to review 
Medicaid provider actions, audit claims, identify overpayments, and 
educate providers and others on Medicaid program integrity issues. (See 
42 U.S.C. § 1396u-6.) 


What Is the Purpose of the IPRO Audit?	
As an Audit MIC, IPRO will perform audits to ensure that Medicaid 
payments are for covered services that were actually provided and 
properly billed and documented. 


Which Providers Will Be Subject to Audit?	
Any Medicaid provider may be audited, including but not limited to, fee- 
	for-service providers. Managed care entities, although excluded from the 
first phase, will eventually be included in the program.


How Are Providers Selected?		
Providers are selected for audits based on data analysis by other CMS
contractors, or on a referral from MassHealth. Those providers selected 
for an audit will receive a notification letter from IPRO. 

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MassHealth
All Provider Bulletin 200
January 2010
Page 2


What Should a Provider Do If It Receives a Notification Letter That It Has Been Selected for Audit?	
A provider receiving an IPRO notification letter should gather the 
requested documents as instructed in the letter and cooperate with 
IPRO. Requested records must be made available to IPRO within the 
requested timeframes. As an Audit MIC, IPRO is authorized to request 
and review copies of provider records and interview providers and office 
personnel. IPRO is also authorized to access provider facilities. 

	IPRO will also contact the provider to schedule an entrance conference. 
Notification letters will identify a primary point of contact at IPRO to 
answer questions about the notification letter or audit process.


What Process Will Follow the Completion of the Audit?		
IPRO will prepare a draft audit report for CMS’s review. Before CMS 
finalizes and issues the report, MassHealth and the provider will
have an opportunity to review the report and comment. Once CMS 
finalizes the report, CMS will issue the report to MassHealth for collection 
of any overpayments.


Additional Information	
For information about the Medicaid Integrity Program, please e-mail 
Medicaid_Integrity_Program@cms.hhs.gov. 

Comprehensive Plan 2007-2011 
http://www.cms.hhs.gov/DeficitReductionAct/Downloads/CMI
P2007.pdf 	
Other Medicaid Integrity Program helpful documents in PDF 
format
Medicaid Integrity Program A to Z
Medicaid Integrity Program (MIP) Provider Audits FAQs