Federal and State Program Integrity

Connecticut safeguards the integrity of federal and state programs by:

• Imposing liability on individuals that submit false claims for payment from the medical assistance program or otherwise attempt to defraud the program.1
• Imposing liability on individuals that make false statements on documents that licensed health care institutions must furnish to the Department of Public Health or maintain on file.2
• Prohibiting Medicare and Medicaid vendors from participating in the programs if they have been convicted of a Medicare or Medicaid fraud3 and terminating vendor participation if they “willfully refuse” to refund an individual that pays for covered services before their eligibility was determined.4
• Suspending payments to hospitals that submit false cost data and imposing liability on individuals that “knowingly” submit false data. 5
• Imposing liability on health care providers that fail to comply with claims and record requirements while participating in certain federal demonstration projects.6
• Fining health care providers that overcharge for Medicare covered services or equipment.7
• Investigating pharmacies that submit a high number of improper payment claims8 or improperly bill brand name drugs. 9
• Establishing “a state-wide fraud early detection system” that can identify fraudulent applications for state programs, including Medicaid, before granting assistance.10