UPIC Medicaid Audit Notification

5/7/2025

Dear Provider,

Your organization may be required to respond to an audit and MDHHS wanted to ensure you had the appropriate information should that occur.

The Centers for Medicare and Medicaid Services (CMS) utilizes Unified Program Integrity Contractors (UPIC) to perform Medicaid integrity functions. Section 1936 of the Social Security Act (the Act), established by the Deficit Reduction Act (DRA) of 2005, is the statutory authority under which the UPICs operate their Medicaid functions. Section 1936(a) of the Act provides that the Secretary must enter into contracts with eligible entities to conduct certain activities specified at section 1936(b) of the Act. Section 1936(b) of the Act provides that eligible entities under contract with the Centers for Medicare & Medicaid Services (CMS) can audit claims for payment for items or services furnished under a state plan as well as identify overpayments made to individuals or entities receiving federal funds under Medicaid to determine whether fraud, waste, or abuse has occurred or is likely to occur. CoventBridge (USA) Inc. (CoventBridge) is the UPIC for the Midwestern Jurisdiction.

In the coming months, you may receive a written request, from CoventBridge, for medical records to support sampled claims. The information requested will be necessary to properly evaluate these claims to determine if claims submitted met applicable Federal and State Medicaid laws, regulations, and policies. This audit period for this review is October 1, 2022, through September 30, 2024.

In accordance with the DRA and other applicable Federal laws, you will be required to provide CoventBridge with the medical records requested.

Your Partner in Care,

Meridian Regulatory Affairs