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CMS Risk Adjustment Data Validation (RADV) Practice Exam

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What is the Medicaid Integrity Program (MIP)?
Correct Answer:
A program created by the Social Security Act to conduct audits of Medicaid providers, including managed care entities.
Explanation:
The Medicaid Integrity Program is a federal effort established under the Social Security Act to protect the Medicaid program from improper payments. Its main purpose is to identify, deter, and recover fraud, waste, and abuse by conducting audits and reviews of Medicaid providers, including managed care entities, using data analysis andProvider billing review. It supports states with audits, training, and guidance, coordinating with CMS and other program integrity activities to strengthen compliance and oversight. This focus is specific to Medicaid and differs from initiatives like hospital expansion funding, veterans’ health services, or Medicare Part D oversight, which fall outside MIP’s scope.

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