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Learn more about RAC reviews at the Centers for Medicare & Medicaid Services
Purpose: to detect and correct past in proper payments so that CMS carriers, Fiscal Intermediaries (FI) and Medicare Administrative Contractors (MAC) can implement actions that will prevent improper payments.
Learn more about MIC reviews at the Centers for Medicare & Medicaid Services
Purpose: Deficit Reduction Act of 2005 (Section 136 of the Social Security Act) provided for the creation of the Medicaid Integrity Program (MIP) and increased the federal government’s role and responsibility in combining medical fraud and waste and abuse. Section 136 of the Act requires CMS to enter into contract with MICS.
Any Medicaid provider may be audited, including but not limited to, the fee-for-service providers, institutional and non-institutional, as well as managed care entities.
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