Program Integrity

Health First Colorado (Colorado's Medicaid Program) and Child Health Plan Plus (CHP+) provider fraud, waste, and abuse can involve physicians, pharmacists, and medical equipment companies.  

The professional staff of our Program Integrity Section includes nurse reviewers and claims reviewers to detect inappropriate payments to Health First Colorado and CHP+ providers and to detect possible fraud.  Our goal is to monitor providers for compliance with statutes and rules, and to recover inappropriate payments from providers.  We also educate employees of providers and contractors about false claims statutes and conduct preliminary investigations on suspected fraud. 

The Program Integrity Section works closely with the Medicaid 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