The IntegrityM Blog

Healthcare Secret Shopping: An Effective Tool for Detecting Fraud and Abuse

The Government Accountability Office (GAO) made headlines recently when sharing news that 11 of 12 fictitious applicants obtained coverage for health insurance through the Federal marketplace. GAO targeted the Federal marketplace with secret shopping – constructing fictitious applicants who should not have received health insurance. The secret shopping applicants provided invalid Social Security information or […]

Read More

Ambulance Billing Fraud and False Claims

Medicare ambulance claims, just like everything involved with Medicare, must meet certain requirements to be considered valid ambulance transport claims. The main factor is the transport must be considered “medically necessary” under Federal Law. To do this, two specific criteria must be met: The use of other transportation methods is contraindicated by the condition of […]

Read More

Electronic Health Record Challenges: A Look at EHR Fraud, Security Issues, & Adoption Barriers

Since the late 20th to early 21st century, reports such as “To Err is Human” by the Institute of Medicine have been published and have advocated the adoption of electronic health records (EHRs). EHRs offer tools to mitigate human error, be a medium to share personal medical records securely across the country, establish electronic communications […]

Read More

  • Author: IntegrityM
  • Date: July 10, 2015
  • Category:

Medicaid Dental Fraud, Waste and Abuse Reporting

OIG has just released the last in a series of four Medicaid dental fraud reports.  The reports identified dentists and orthodontists with questionable billing practices in New York, Louisiana, Indiana, and California.  These reports are just one part of OIG’s multi-faceted approach to combat dental fraud.  The agency also has ongoing audits of Medicaid dental […]

Read More

Identifying Fraud is Not Always Easy: Analyzing State Medicaid Fraud Control Unit Reports

The U.S. Department of Health and Human Services Office of Inspector General (OIG) recently released a data chart offering fiscal year (FY) 2014 statistical data for the Medicaid Fraud Control Units. For those of you unfamiliar with Medicaid Fraud Control Units (MFCU), the MFCUs are: single identifiable entities of State government that conduct a Statewide […]

Read More


Contact Us

Get Industry Blog Updates Directly to Your Inbox