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CMS Manual SystemDepartment of Health & Human Services (HHS)Pub 10015 Medicaid Program IntegrityCenters for Medicare & Medicaid Services (CMS)Transmittal 11948Date: April 13, 2023Change Request 13141 SUBJECT:
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Who needs medicaid program integrity manual?

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Medicaid program providers, administrators, and personnel who are involved in ensuring the integrity and compliance of Medicaid programs.
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Regulatory agencies and auditors responsible for overseeing and evaluating Medicaid program integrity.
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Healthcare professionals and organizations participating in Medicaid programs.
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Anyone interested in understanding the guidelines and procedures for maintaining the integrity of Medicaid programs.
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The Medicaid Program Integrity Manual provides guidelines and standards for the administration of Medicaid program integrity initiatives, ensuring proper management of Medicaid funds and preventing fraud, waste, and abuse.
Entities involved in the administration of Medicaid, including state Medicaid agencies and providers, are typically required to file and comply with the Medicaid Program Integrity Manual.
To fill out the Medicaid Program Integrity Manual, entities should follow the specific instructions provided within the manual, ensuring they include all necessary information and adhere to established guidelines.
The purpose of the Medicaid Program Integrity Manual is to promote accountability and integrity in Medicaid programs, providing a framework for preventing and detecting fraudulent activities and ensuring compliance with federal and state regulations.
The information that must be reported typically includes details about Medicaid expenditures, compliance with program requirements, provider qualifications, and measures taken to prevent fraud and abuse.
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