Program Integrity Unit

What We Do

The Program Integrity Unit (PIU) works to establish and maintain integrity within the Medicaid Program and engages in activities to prevent, detect and investigate Medicaid provider and beneficiary fraud, waste and abuse. 

Who We Serve

The PIU serves the Medicaid recipients and taxpayers of Vermont.  We protect the integrity of Medicaid payments to providers and the enrollment of Medicaid-eligible Vermont citizens to ensure taxpayer dollars are spent on the health and welfare of the recipients that need it.

How We Impact

By identifying and preventing fraud, waste and abuse from providers and beneficiaries which diverts dollars that could otherwise be spent to safeguard the health and welfare of Medicaid recipients. The fraud, waste and abuse we prevent and detect means there are more funds available for the recipients that really need it. We ensure services were provided as billed, were medically necessary, and at the proper cost.

Action Plan

The 2 top priorities/initiatives for the PIU in SFY20 are:

  • To monitor all PI initiatives defined in the ACO contract with the ACO that will establish a strong compliance program.
  • To identify audit projects and measure cost avoidance from PI involvement.
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