Which term describes a private company contracted by CMS to perform audit-related activities?

Which term describes a private company contracted by CMS to perform audit-related activities?

• A. Medicaid Integrity Contractor
• B. Medicare Administrative Contractor
• C. National Provider Identifier
• D. Office of Audit Services

Answer: (A)

CMS recruits private companies to support audit-related work within Medicaid, aiming to detect and deter fraud, waste, and abuse. These private entities are known as Medicaid Integrity Contractors, and they perform audits, data analysis, and investigations to ensure Medicaid program integrity. The other terms describe different functions: Medicare Administrative Contractors focus on processing and paying Medicare claims, not Medicaid audits; the National Provider Identifier is simply a unique ID assigned to providers; and the Office of Audit Services is an internal CMS unit that conducts audits, not a private contractor.

CMS recruits private companies to support audit-related work within Medicaid, aiming to detect and deter fraud, waste, and abuse. These private entities are known as Medicaid Integrity Contractors, and they perform audits, data analysis, and investigations to ensure Medicaid program integrity. The other terms describe different functions: Medicare Administrative Contractors focus on processing and paying Medicare claims, not Medicaid audits; the National Provider Identifier is simply a unique ID assigned to providers; and the Office of Audit Services is an internal CMS unit that conducts audits, not a private contractor.