Medicaid integrity program; limitation on contractor liability. Final rule.
The Medicaid Integrity Program (the Program) provides that the Secretary promote the integrity of the Medicaid program by entering into contracts with contractors that will review the actions of individuals or entities furnishing items or services (whether fee-for-service, risk, or other basis) for which payment may be made under an approved State plan and/or any waiver of the plan approved under section 1115 of the Social Security Act; audit claims for payment of items or services furnished, or administrative services furnished, under a State plan; identify overpayments of individuals or entities receiving Federal funds; and educate providers of services, managed care entities, beneficiaries, and other individuals with respect to payment integrity and quality of care. This final rule will provide for limitations on a contractor's liability while performing these services under the Program. The final rule will, to the extent possible, employ the same or comparable standards and other substantive and procedural provisions as are contained in section 1157 (Limitation on Liability) of the Social Security Act.
D003284:Contract Services / Q000331:legislation & jurisprudence*; D005607:Fraud / Q000331:legislation & jurisprudence / Q000517:prevention & control*; D006801:Humans; D016365:Liability, Legal; D008484:Medicaid / Q000331:legislation & jurisprudence*; D014481:United States