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Initiation of Collaborative Investigations Between States and CMS’s Unified Program Integrity Contractors

This measure reports the states that have initiated collaborative investigations with the Centers for Medicare & Medicaid Services’ Unified Program Integrity Contractors (UPICs) in federal fiscal year 2018.  States, CMS, and UPICs can collaborate to undertake joint investigative work in specific areas of interest. A collaborative investigation is initiated once the investigative target(s) have been vetted and cleared by law enforcement. This means that law enforcement does not have a concern with the investigation proceeding. CMS encourages state participation in collaborative investigations with the UPICs, but states are not required to do so. Not all states have yet had an opportunity to engage in collaborative investigations with a UPIC because the UPICs were implemented recently.  CMS will continue to work with and support states and UPICs.

CMS and the states share joint responsibility for program integrity activities and safeguarding taxpayer dollars for Medicaid and the Children's Health Insurance Program (CHIP). CMS has identified this program integrity measure as part of its plan to reform Medicaid using the three pillars of flexibility, accountability, and integrity.