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Surveillance and Utilization Review

Surveillance and Utilization Review

The program that protects the integrity of Montana Medicaid from Provider fraud, waste and abuse is known as the Surveillance and Utilization Review (SURS).  It identifies aberrant billing practices, sanctions those who have abused Medicaid, recovers overpayments, and assists in criminal investigations where appropriate.

Provider fraud is the criminal act of intentionally filing a false claim. Typically, the claim is for services that were not actually rendered. When there is reliable evidence of fraud, the provider is referred to the state's Medicaid Fraud Control Unit of the Attorney General's Office for criminal investigation.

Providers are selected for review based on creditable information that points to an irregularity. The computer detection process screens all provider billing services to flag unusual practices. SURS may also receive referrals from other governmental entities and from the public.

When an analysis of a provider's records shows that program rules have been misinterpreted or violated, a sanction may be imposed. This may range from a warning letter to a criminal charge. No sanction is imposed without the provider receiving full appeal rights.

If you suspect fraud or abuse by an enrolled Medicaid provider, you may call the Program Compliance Bureau's Provider fraud hotline. You may report anonymously.

For more information about SURS

Recipient Eligibility Fraud Hotline: 800-201-6308
Recipient Abuse (Team Care) Fraud Hotline: 800-362-8312
Provider Fraud Hotline: 800-376-1115

Surveillance and Utilization Review Supervisor
Jennifer Tucker
(406) 444-4586
jtucker2@mt.gov