What entity audits Medicaid claims to identify overpayment and can look back 5 years?

The Medicaid Integrity Contractor (MIC) serves as a crucial entity in the auditing process of Medicaid claims. One of its primary responsibilities is to identify instances of overpayment within the Medicaid system. MICs have the authority to go back up to five years in their audit processes. This long look-back period is important for thoroughly analyzing claims to ensure compliance with Medicaid regulations and to promote accountability within the program.

The role of the MIC is specifically focused on program integrity, which includes identifying fraud, waste, and abuse. By conducting audits, the MIC helps to protect taxpayer dollars and ensures that funds are being used appropriately within Medicaid. The proactive measures taken by these contractors ultimately support the overall integrity of the Medicaid program.

Other options listed do not have the same level of authority or specific focus on Medicaid claim audits. The details of their functions differ significantly from the specific responsibilities of the MIC in overseeing Medicaid claims.