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CMS Contracted Provider Audits

CMS Medicaid Integrity Contractors (MIC)

 
Section 1936 of the Social Security Act obligates the Centers for Medicare & Medicaid Services (CMS) to procure contractors to audit Medicaid claims and identify overpayments. To fulfill this statutory requirement, CMS has procured Audit Medicaid Integrity Contractors (Audit MICs) to conduct provider audits throughout the country. 
 
 

Payment Error Rate Measurement (PERM) 

The Improper Payments Information Act (IPIA) of 2002 (amended in 2010 by the Improper Payments Elimination and Recovery Act or IPERA) requires the heads of Federal agencies to annually review programs they administer and identify those that may be susceptible to significant improper payments, to estimate the amount of improper payments, to submit those estimates to Congress, and to submit a report on actions the agency is taking to reduce the improper payments. The Office of Management and Budget (OMB) has identified Medicaid and the Children's Health Insurance Program (CHIP) as programs at risk for significant improper payments. As a result, CMS developed the Payment Error Rate Measurement (PERM) program to comply with the IPIA and related guidance issued by OMB.
 
 The PERM program measures improper payments in Medicaid and CHIP and produces error rates for each program. The error rates are based on reviews of the fee-for-service (FFS), managed care, and eligibility components of Medicaid and CHIP in the fiscal year (FY) under review. It is important to note the error rate is not a “fraud rate” but simply a measurement of payments made that did not meet statutory, regulatory or administrative requirements. FY 2008 was the first year in which CMS reported error rates for each component of the PERM program.