Program Integrity

Sandhills Center's Program Integrity (PI) department investigates fraud, waste and abuse of the Medicaid program and IPRS system.

Examples of Fraud:

• Billing services not provided
• Falsifying credentialing application
• Falsifying client records
• Kickbacks

Examples of Waste and Abuse:

• Providing services not medically necessary.
• Failure to adhere to the requirements of the service definition.
• Using treatments that are not evidence-based.
• Using a higher cost treatment when a lower cost treatment could be equally effective.

Providers' responsibilities during an investigation or post-payment review:

• Cooperate
• Provide requested records
• Communicate with program integrity staff as necessary

The Program Integrity department's responsibilities during an investigation or post-payment review:

• Minimize disruption to client services.
• Approach each investigation or review without bias.
• Communicate with providers as allowed by policy, rule and law.

To report Fraud, Waste or Abuse:

• Call Sandhills Center 24 hours a day, seven days a week - 1-800-256-2452.
• Call the Sandhills Center Program Integrity department directly - 336-389-6236.
• Use the Fraud Referral Form
• Contact the Attorney General's Medicaid Investigation Division - 919-881-2320.

Helpful Resources:

• Office of the Inspector General "Compliance 101"
• Center for Medicare and Medicaid Services (CMS) Fraud, Waste and Abuse Toolkit