Program Integrity in Iowa Medicaid

Our Mission

Provide systems of sustainable and equitable oversight that targets accountability and compliance, focusing on prevention of fraud, waste, and abuse of Medicaid programs.

Our Purpose

Ensure state and federal taxpayer dollars are spent appropriately on delivering quality services, necessary care, and preventing fraud, waste, and abuse within the Medicaid Programs.

Program Integrity Department 

Program Integrity Responsibilities

• Federal and state rules regulation governance and enforcement
• Provider enrollment and screening oversight
• Exclusions and Sanctions
• Program Integrity Oversight
  • Medical Benefit Managers
  • Managed Care Organizations (MCOs)
• Dental Benefit Managers (DBMs)
• Fraud, Waste, and Abuse Audits and Investigations
• Payment Error Rate Measurement (PERM) Audits
• Post-Pay Overpayment Recoveries

Iowa Medicaid Sanction List

View at Iowa Medicaid Sanction List.

• A list of providers that are found to be in violation of the Iowa Medicaid Program.
• The list identifies all individuals, organizations, and entities that Iowa Medicaid Program Integrity Unit has taken an adverse action against for the following reasons:
  • Involuntarily Terminated from Participation
  • Involuntarily Suspended from Participation
  • OIG Excluded
  • Medicare Revocations
  • Outstanding Overpayments
• Sanction list verifications should be sent to iaverify@dhs.state.ia.us

Resource Library

The Program Integrity Resource Library page can be found here.

Education and Training Resources

Program Integrity Education and Training Resources can be found here.

Payment Error Rate Measurement (PERM)

The PERM page can be found here.

Program Integrity Forms

• Deficit Reducation Act (DRA) Form 470-5506
• Program Integrity TIP Form
• Whistleblower Policy and Form

Contact Us

• Exclusions and Sanctions
  • imepi@dhs.state.ia.us
• Medicaid Fraud Control Unit (MFCU)
• Report Adult/Child Abuse and Medicaid Fraud
• Program Integrity Unit
  • Operating Hours
    • Monday - Friday 8:00 AM - 4:30 PM
  • 877-446-3787 (Toll Free)
  • Clinical Record Request/Payments related to findings/Report Fraud
    • Contact Information
      • PO Box 36390 Des Moines, IA 50315
      • 877-446-3787 (Toll Free)
      • 515-256-4615 (Des Moines Area)
      • 5157251354 (Fax)
• Managed Care Organizations (MCOs)
  • Amerigroup of Iowa, Inc. (Amerigroup)
  • Iowa Total Care
• Dental Benefit Managers (DBMs)
  • Delta Dental of Iowa, Inc. (Delta Dental)
  • MCNA