1
00:00:00,079 --> 00:00:02,179
Follow the Medicaid money with records, not

2
00:00:02,398 --> 00:00:03,378
conclusions. Build a seven-field funding trail:

3
00:00:03,798 --> 00:00:06,177
program and service; authorization; claim identifier; rendering

4
00:00:06,478 --> 00:00:07,998
provider; amount and date; federal-state funding share;

5
00:00:08,338 --> 00:00:10,536
audit or recovery status. Medicaid program-integrity

6
00:00:10,797 --> 00:00:13,057
rules require states to address fraud and

7
00:00:13,095 --> 00:00:15,115
abuse, while federal and state roles differ.

8
00:00:15,155 --> 00:00:18,214
A paid claim, concentration, duplicate-looking entry,

9
00:00:18,274 --> 00:00:21,254
disputed service, or improper payment does not

10
00:00:21,293 --> 00:00:25,132
by itself prove fraud, intent, kickbacks,

11
00:00:25,192 --> 00:00:28,551
retaliation, or civil-rights liability. Reconcile claims with

12
00:00:28,731 --> 00:00:31,591
authorizations, service logs, provider enrollment, payment adjustments,

13
00:00:31,651 --> 00:00:35,729
encounter data, and final audit findings.

14
00:00:35,789 --> 00:00:39,249
Mark allegations, referrals, recoveries, and adjudications separately.

15
00:00:39,288 --> 00:00:42,688
Use consistent definitions across agencies and periods.

16
00:00:42,728 --> 00:00:45,587
Document each adjustment, denial, appeal, and

17
00:00:45,647 --> 00:00:48,626
final disposition. Read the checklist at david-medeiros.com/medicaid-money.