The IntegrityM Blog


Using the CIGIE Quality Standards for Inspection and Evaluation

It is important for every industry to have a framework of quality standards by which to measure performance and to establish credibility.  Most people have heard of the Yellow Book, or The Generally Accepted Government Auditing Standards, that is used by audit organizations.  Evaluation work does not have a well-known equivalent and organizations are often […]

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Veterans Affairs Health Care Added to GAO High Risk List

In 2015, the Veterans Affairs (VA) Health Care achieved a distinction held by two other large Federal health care programs – Medicare and Medicaid – that of being designated a Government Accountability Office (GAO) high risk program. VA Health Care was added to the GAO High Risk List in response to its problems providing adequate […]

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OIG Work Plan for 2016 Highlights New Program Evaluations and Oversight

The HHS OIG released its Work Plan for FY 2016 on November 2nd. The Work Plan outlines audits, evaluations, and other activities OIG is conducting or plans to conduct in the coming fiscal year. Much of the planned work for FY 2016 focuses on cut and dry payment reviews with the goal of identifying and […]

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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 […]

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Medicaid Encounter Data Problems Continue

In May 2009, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released a report regarding Medicaid managed care encounter data.  The OIG found all 40 States with capitated managed care reported collecting encounter data from their managed care plans. However; 15 States did not include encounter data in their Medicaid Statistical […]

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