The mission of the Division of Program Integrity is to provide a reasonable and consistent system of oversight of the Medicaid program which effectively encourages:
- Protection of public funds
- Awareness and responsibility
- Providers meeting participation requirements
- Services being medically necessary
- Payments in the correct amount for covered services
The goal is to reduce and eliminate fraud, waste, and abuse in the Medicaid Program.
The duties of Program Integrity include prevention; investigation; education; audit; recovery of improper payments; and cooperation with the Medicaid Fraud Control Unit (MFCU) and other federal/local law enforcement agencies.
The Investigations Branch is responsible for conducting investigations of alleged violations of policies, procedures, rules or laws. Complaints may originate from the Office of Inspector General, the FRAUD Hotline, Agency staff, facilities and/or health care practitioners, the general public, data analysis, or other sources. Allegations of a criminal nature are referred to the appropriate law enforcement entity. When necessary, the Investigations Section works closely with the District of Columbia Medicaid Fraud Control Unit (MFCU) and other federal or local law enforcement.
|Preliminary Investigations Policy||Preliminary Investigations Report|
|Complaint and Referral Intake Policy||Suspension of Provider Payments|