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42 U.S. Code § 1396u-6. Medicaid Integrity Program
(a) In general
There is hereby established the Medicaid Integrity Program (in this section referred to as the “Program”) under which the Secretary shall promote the integrity of the program under this subchapter by entering into contracts in accordance with this section with eligible entities, or otherwise, to carry out the activities described in subsection (b).
(b) Activities describedActivities described in this subsection are as follows:
(1)
Review of the actions of individuals or entities furnishing items or services (whether on a fee-for-service, risk, or other basis) for which payment may be made under a State plan approved under this subchapter (or under any waiver of such plan approved under section 1315 of this title) to determine whether fraud, waste, or abuse has occurred, is likely to occur, or whether such actions have any potential for resulting in an expenditure of funds under this subchapter in a manner which is not intended under the provisions of this subchapter.
(2) Audit of claims for payment for items or services furnished, or administrative services rendered, under a State plan under this subchapter, including—
(A)
cost reports;
(B)
consulting contracts; and
(C)
risk contracts under section 1396b(m) of this title.
(3)
Identification of overpayments to individuals or entities receiving Federal funds under this subchapter.
(4)
Education or training, including at such national, State, or regional conferences as the Secretary may establish, of State or local officers, employees, or independent contractors responsible for the administration or the supervision of the administration of the State plan under this subchapter, providers of services, managed care entities, beneficiaries, and other individuals with respect to payment integrity and quality of care.