Audit Protocols

Audit protocols assist the Medicaid provider community in developing programs to evaluate compliance with program requirements. The protocols listed are intended solely as guidance in this effort. This guidance does not constitute rulemaking by the OMIG and may not be relied on to create a substantive or procedural right or benefit enforceable, at law or in equity, by any person.

Furthermore, nothing in the protocols alters any statutory or regulatory requirement. In the event of a conflict between statements in the protocols and either statutory or regulatory requirements, the requirements of the statutes and regulationsgovern.

The audit protocols do not encompass all the current requirements for payment of Medicaid claims for a particular category of service or provider type and therefore are not a substitute for a review of the statutory and regulatory law. A Medicaid provider's legal obligations are determined by the applicable federal and state statutory and regulatory law.

Audit protocols are applied to a specific provider or category of service in the course of an audit and involve the OMIG's application of articulated Medicaid agency policy and the exercise of agency discretion.

Protocols are amended as necessary. Reasons for amending protocols include, but are not limited to, responding to a hearing decision, litigation decision, or statutory or regulatory change.

Links to several OMIG audit protocols are listed below.