Program Integrity - Provider Reviews
Program Integrity conducts on-going audits/reviews of all MaineCare providers and their claims for services. PI reviews generally consist of claims data information and the clinical/professional/financial record supporting the services or products that were billed to, and paid for by the MaineCare Program. The main focus of the reviews is to ensure that billings are in compliance with all MaineCare rules and regulations and to detect and deter areas of fraud, abuse, and waste.
Examples of fraud, abuse, and waste include, but are not limited to:
- Billing for services not provided;
- Billing for medically unnecessary services;
- Billing for non-covered services disguised as a covered service;
- Pre-billing services;
- Listing phantom employees on budgets used for rate setting;
- Poor or no documentation to support the services billed.
Program Integrity Contact Information:
11 State House Station
Augusta, ME 04333-0011