The Special Investigations Unit (SIU) works to establish and maintain integrity within the Medicaid Program and engages in activities to prevent, detect and investigate Medicaid provider and beneficiary fraud, waste and abuse. 

The SIU serves the Medicaid recipients and taxpayers of Vermont.  We protect the integrity of Medicaid payments to providers and the enrollment of Medicaid-eligible Vermont citizens to ensure taxpayer dollars are spent on the health and welfare of the recipients that need it.

By identifying and preventing fraud, waste and abuse from providers and beneficiaries which diverts dollars that could otherwise be spent to safeguard the health and welfare of Medicaid recipients. The fraud, waste and abuse we prevent and detect means there are more funds available for the recipients that really need it. We ensure services were provided as billed, were medically necessary, and at the proper cost.

SFY23 priorities are:

• Work with Pharmacy Unit – Controlled Substances monitoring and analysis
• Continue micro audits
• Proactive Analytics