The Program Compliance Bureau is part of the Quality Assurance Division of the Montana Department of Public Health and Human Services. It encompasses three units:
- Program Integrity unit investigates allegations of intentional fraud of recipient eligibility in the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and Low Income Energy Assistance Program (LIEAP). Performs federally mandated quality-control reviews for the SNAP and Medicaid programs.
- Quality Control unit conducts federally mandated random reviews of recipient eligibility in the SNAP and Medicaid programs. These reviews are conducted to provide information on the accuracy of eligibility determinations. The results of these reviews are used as a basis to reduce or eliminate the causes of incorrect payments made to recipients.
- Surveillance and Utilization Review unit is responsible for protecting the integrity of the Montana Medicaid Program from fraud, waste and abuse.
- Third Party Liability unit manages estate recovery, Medicare buy-in, casualty recovery, Health Insurance Premium Payments (HIPP) and the collection of benefit over-issuance.
The Program Compliance Bureau also monitors Payment Error Rate Measurement (PERM) and Recovery Audit Contract (RAC).
- The Payment Error Rate Measurement (PERM) was developed by CMS to comply with rules and guidance issued by the Federal Office of Management and Budget. PERM reviews payments for fee-for-service, managed care and eligibility for Medicaid and CHIP. PERM is administered by CMS.
- The Recovery Audit identifies and recovers improper Medicaid payments. Each state is in charge of their RAC Audits.
To contact the Program Compliance Bureau
Recipient Eligibility Fraud Hotline: 800-201-6308
Recipient Abuse (Team Care) Fraud Hotline: 800-362-8312
Provider Fraud Hotline: 800-376-1115
Program Compliance Bureau Chief
Quality Control Supervisor
PERM / IPV Supervisor
Surveillance and Utilization Review Supervisor
Third Party Liability Supervisor
Primary PERM Contact
Recovery Audit Coordinator
Krista Cronholm Interim