Welcome to Program Integrity
The Division of Medicaid and Medical Assistance Program Integrity Unit is responsible for activities related to the prevention, detection and investigation of alleged fraud, waste and abuse in the Medicaid program. Program Integrity encourages compliance through education, prevention, audits, third party liability and recovery of improper payments.
Every dollar lost to the misuse of Medicaid benefits, is one less dollar available to fund programs providing essential medical services for the vulnerable citizens of Delaware. Let’s work together to prevent and eliminate fraud, waste and abuse in the Medicaid program.
What is Fraud and Abuse?
Fraud is defined by the Code of Federal Regulations(42 CFR 455.2) as
An intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other persons. It includes any act that constitutes fraud under applicable Federal or State law.
Abuse is defined by the Code of Federal Regulations(42 CFR 455.2) as
Provider practices that are inconsistent with sound fiscal, business, or medical, and result in an unnecessary cost to the Medicaid program, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes recipient practices that result in unnecessary cost to the Medicaid program.
The Office of Inspector General (OIG) has the authority to exclude providers from Medicaid participation for various reasons.
Stop Medicaid Fraud Now!
To submit anonymously, Call 1-800-372-2022 or click here