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Follow the Medicaid money with records, not

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conclusions. Build a seven-field funding trail:

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program and service; authorization; claim identifier; rendering

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provider; amount and date; federal-state funding share;

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audit or recovery status. Medicaid program-integrity

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rules require states to address fraud and

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abuse, while federal and state roles differ.

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A paid claim, concentration, duplicate-looking entry,

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disputed service, or improper payment does not

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by itself prove fraud, intent, kickbacks,

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retaliation, or civil-rights liability. Reconcile claims with

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authorizations, service logs, provider enrollment, payment adjustments,

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encounter data, and final audit findings.

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Mark allegations, referrals, recoveries, and adjudications separately.

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Use consistent definitions across agencies and periods.

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Document each adjustment, denial, appeal, and

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final disposition. Read the checklist at david-medeiros.com/medicaid-money.