Program Integrity

Provider fraud, waste, and abuse can involve physicians, pharmacists, and medical equipment companies.  

The professional staff of the Program Integrity Section includes nurse reviewers and claims reviewers to detect inappropriate payments to Health First Colorado (Colorado's Medicaid Program) providers and to detect possible fraud.  Our goal is to conduct monitoring of Health First Colorado providers for compliance with Medicaid statutes and rules, and to recover inappropriate payments from Medicaid providers.  Compliance monitoring includes administration of the program to educate employees of providers about false claims.

We also conduct preliminary investigations on suspected fraud.  The Program Integrity Section works closely with the Health First Colorado Fraud Control Unit at the State of Colorado Attorney General’s office regarding suspected fraud. 

You can help us by reporting suspected fraud, waste or abuse by Health First Colorado providers or members.

You may also contact the Office of Inspector General, U.S. Department of Health and Human Services Fraud Hotline