Please complete this survey by April 15, 2026—it should take less than 10 minutes to complete: NAMPI Program Integrity 360 (PI-360) Feedback Survey – 2026

The NAMPI Board is excited to share progress on a key initiative!
Over the past year, we gathered Program Integrity data and statistics from states and territories, and we are proud to…

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Hi Vanessa, and thank you for sharing.

I also found the numbers in this MFCU annual report to be quite interesting.

https://oig.hhs.gov/reports/all/2026/medicaid-fraud-control-units-annual-report-fiscal-year-2025/

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Please see attached report from HHS OIG

NAMPI is soliciting anonymous feedback to compile and review with NAMD and NAMFCU for a submission in response to the latest RFI from CMS. This request for information (RFI) solicits stakeholder feedback on potential regulatory changes that might be included in a potential upcoming CRUSH proposed rule, as well as other programmatic changes…

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@Frank_Walsh @Tamara_McNatt @Joan_Senatore @lstiles

Bumping this to our membership base so they can see this. Thank you in advance if you choose to submit information.

NAMPI is soliciting anonymous feedback to compile and review with NAMD and NAMFCU for a submission in response to the latest RFI from CMS. This request for information (RFI) solicits stakeholder feedback on potential regulatory changes that might be included in a potential upcoming CRUSH proposed rule, as well as other programmatic changes…

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I will send it shortly through a secure drop file.

If you don’t mind, that would be greatly appreciated! If you can email me at kevin.odonnell2@dc.gov I’ll owe you one 😉

Hi Kevin,

The project, Program Integrity 360, that I worked on last year has this information. The request has been submitted to add the information collected to the NAMPI Portal Resource Library. As soon as the information is uploaded, I will let you know. If this is an urgent request, let me know and I can share my spreadsheet with you directly.

I have heard through the grapevine that NAMPI has a document that lays out the structure of each state’s program integrity divisions. I can’t seem to find anything along those lines on the NAMPI webpage, but wanted to reach out to see if anyone else was familiar with it (or of another source that would have such a document). Looking for…

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We do. We are on our 3rd annual Employee Celebration. Our awards include the following:

•Mentorship Award = Employee who has provided training and guidance to others and didn’t have to be asked to do it. Volunteer, not “Voluntold”.

•Creative Problem Solving Award = Saw a problem or process that was not working and came up with a…

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January 2026

Join the PARIS Board of Directors – A Chance to Make a National Impact!

Are you passionate about driving program integrity at a national level? Or do you know someone whose expertise would make a difference? The PARIS Board of Directors is excited to announce multiple openings and is seeking nominations to join our dynamic team. This is an…

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For states that have a RAC, do you reimburse them for identifying underpayments? If so, are the underpayments paid from the overpayment recoveries?

Hi Melissa,

In New York, we recognize our program integrity staff annually in much the same way as Idaho, it is not specific to a particular audit or investigation per sei but recognizes their unique contribution to our program integrity mission. Any employee can nominate and then a committee from all Divisions from within the agency…

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Hi Melissa,

In Tennessee, we hold an annual Summit (it’s like a mini-NAMPI) where attendees from all of our Managed Care Contractors, MFCD, Attorney General’s Office, and various other State partners. At that Summit, I recognize the MCO with the most referrals accepted by Law Enforcement every year. Throughout the year, I will also take note…

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Medicaid’s program integrity staff are not recognized as employee of the year or case of the year but individuals with exemplary work can be nominated to receive a director’s award of excellence.

Do any states give out annual awards for exemplary work? We are looking for ways to promote and recognize our staff for the work they do. If you have any examples or programs, please let me know.

Do any states give annual awards for employees to recognize exemplary work? Investigation of the year/audit of the year?

Perfect, I’m really excited for the call for submissions and can’t wait to share my ideas.

Monthly Fraud Trends Notifications

Hi Dustin,

Every year we send out a call for submissions for the conference. This would be a perfect topic for what you are suggesting. We ask for a variety of presentations and items and this sounds like it would be a great addition!

Hi!

Does anyone have a comprehensive policy or framework describing how your SMA complies with the utilization review requirements in 42CFR 456? As we all know, SURs doesn’t just live in post-payment audit, but encompasses many activities across the SMA. We’re wanting to develop a clear, comprehensive outline that links the CFR requirements…

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Happy Friday!!!

I’m interested if any state has a template they provide to their MCO’s for the MCO to report their data mining initiatives? If so, would you mind sharing so Tennessee can use as a guide when developing our own report for this? It can be sent to me at Cindi.Furlough@tn.gov.

Thank you

Thanks Duane! I’ll look forward to more info as that info becomes ready for prime time!

Hi Lynda,

I appreciate your interest in this information, which unfortunately is not yet public. I am working with the NAMPI Board to get this information onto the NAMPI Member Portal site, hopefully soon. Once this information is on the website, we will communicate this to all NAMPI Members through the NAMPI Regional Representatives.

V/r,

Duane

Hi! I wasn’t able to attend the meeting on the last day of NAMPI where I understand the recent state PI survey was going to be discussed. Is there any information on when/if the results of the survey will be made available to states? I’m really interested in seeing the various organizational structures and staff composition, particularly in…

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Looking forward to the 2026 conference. Hopefully it’ll be more the West Coast side.

Is a formal process or format for Managed Care Organizations (MCOs) to participate in the 2026 NAMPI Conference—specifically as part of a discussion group focused on what’s working on the MCO side regarding Fraud, Waste, and Abuse (FWA) programs.

I am interested in contributing to a collaborative session that highlights successful strategies,…

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I appreciate the opportunity to be a NAMPI member and look forward to utilizing the resources and learning new information to help prevent FWA. Thank you!

We are excited to share the new NAMPI member portal with our NAMPI 2025 attendees! Please edit your profile in the top right corner to claim your NAMPI St. Louis Pin! Helping us complete profiles will greatly enhance the search capabilities of the member directory and allow you to connect with members who may have the specific information you…

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We are excited to share the new NAMPI member portal with our NAMPI 2025 attendees! Please edit your profile in the top right corner to claim your NAMPI St. Louis Pin! Helping us complete profiles will greatly enhance the search capabilities of the member directory and allow you to connect with members who may have the specific information you…

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Illinois does not utilize TMSIS for PERM but does use for our UPIC contractor. PERM has direct access. For UPIC, there are discrepancies but that could be explained from the delayed MCO encounter data.

Illinois: 89 Ill. Admin. Code, Section 140.15 Suspension and Denial of Payment, Recovery of Money and Penalties

…

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Idaho’s administrative rule IDAPA 16.05.07.205 states the Department may recoup the amount paid for items or services listed in Section 200 of these rules. In Section 200, it states the Department may deny payment for services not provided or not medically necessary, contrary to rules or provider agreement, or for failure to provide…

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Hi all, we are wondering if your state has Administrative Code that permits recoupment based on policies and topics in your Medicaid handbooks. If so, could you please provide a link to your state’s admin code? Thank you!

Good morning! Wisconsin would be happy to share our MOU via email. Please send me your email address. Thanks!

Thank you so much Rebecca! I appreciate your answer.

Hello, it’s a valid question. We (Louisiana) have asked questions like this to our actuaries before, and generally the actuaries tend not to be concerned about SIU or Program Integrity recoveries, because the service dates tend to be old enough that they do not affect future rates. Our MCOs report financials quarterly, including income…

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Jennifer .. I will send Missouri’s to you .. please email me at Dale.Carr@dss.mo.gov and I will respond with the MOU.

Dale Carr, Director, Missouri Medicaid Audit & Compliance

Maryland is revising its MOU with the MFCU. I am interested in reviewing other State’s MOUs prior to making any changes. Anyone willing to share their MOU? Thanks!

We are trying to get finders’ keepers language added to our MCO contract. Our Division of Medicaid Services was concerned that either the actuaries or the contracting area of CMS may have issues with the addition of this language.

Have any other states ever had problems getting their MCO contract approved due to finders’ keepers language, or…

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