Audit

Overview

A primary function of the Office of Medicaid Inspector General (OMIG) is to conduct Medicaid audits. Audits are done to determine the scope of medical services billed to the Medicaid program, assess compliance with applicable Federal and State laws, rules and policies governing the program, and verify that:

  • Medicaid reimbursable services were rendered for the dates billed
  • Appropriate rate or procedure codes were billed for services rendered
  • Patient related records contained the documentation required by the regulations
  • Claims for payment were submitted in accordance with Department of Health regulations and the appropriate provider manuals

Some of the types of of audits conducted by OMIG include, but are not limited to the County Demonstration Program, Managed Care, Medicaid in Education, Network Provider, Rate, Self-Disclosure and System Match Recovery.

Criteria used during reviews are called protocols. Protocols reflect guidance, rules and regulations that structure the Medicaid program. View the finalized fees for service protocols, developed in consultation with state regulating agencies.