MES Certification Navigator
PI4

CMS-Required Outcome

CMS-required outcome

System can suspend Medicaid payments in whole or in part to providers for whom the agency has determined there is a credible allegation of fraud and is conducting an investigation and other activities, including provide notice of suspension; referrals to MFCU; and documentation and record retention.

Default metrics
  • Track number of PI FWA detection and actionable cases sent ending in payment suspension/All cases initiated
Regulatory sources
  • None cited

Other Program Integrity outcomes