Which term refers to a private contractor performing audits under CMS contract?

Which term refers to a private contractor performing audits under CMS contract?

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

Answer: (A)

The concept here is who CMS hires to specifically audit Medicaid programs. Medicaid Integrity Contractors are private firms contracted by CMS to conduct audits, analyze data, identify improper payments, and support investigations to protect Medicaid funds. They operate under CMS contracts focused on Medicaid program integrity, making them the best fit for “a private contractor performing audits under CMS contract.” Medicare Administrative Contractors, while also private entities under CMS, primarily handle processing of Medicare claims and related program activities, not the Medicaid-specific audit role described. The National Provider Identifier is simply a unique identifier for healthcare providers, not an auditing entity. The Office of Audit Services is an internal CMS unit that conducts audits, not a private contractor working under CMS contracts.

The concept here is who CMS hires to specifically audit Medicaid programs. Medicaid Integrity Contractors are private firms contracted by CMS to conduct audits, analyze data, identify improper payments, and support investigations to protect Medicaid funds. They operate under CMS contracts focused on Medicaid program integrity, making them the best fit for “a private contractor performing audits under CMS contract.”

Medicare Administrative Contractors, while also private entities under CMS, primarily handle processing of Medicare claims and related program activities, not the Medicaid-specific audit role described. The National Provider Identifier is simply a unique identifier for healthcare providers, not an auditing entity. The Office of Audit Services is an internal CMS unit that conducts audits, not a private contractor working under CMS contracts.