Medicaid Fraud Detection Services

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Medicaid is a federally subsidized health care program which operates under the provision of Title XIX of the Social Security Act. The Medicaid program is administered through a Single State Agency (SSA), and cumulatively involves billions of dollars in annual funding derived from federal and state government resources. Medicaid funding is based upon a percentage of state matching funds to federal funds allocated annually to each state which participates in the Medicaid program.

Medicaid provides health care services to children and financially needy recipients not covered by health care services elsewhere. As costs continue to increase due to Medicaid fraud and abuse, the effects of Medicaid provider fraud do not only impact Medicaid programs, but funding for other state programs as well.

A lack of state matching funds to allocated federal funds ultimately disallows use of federal funds marked for Medicaid health care services to a state’s most needy recipients and to vulnerable elder adults. State legislatures give Medicaid fraud interdiction efforts the highest priority to prevent the loss of funds due to Medicaid provider fraud or mismanagement. The need for experienced, results-driven professionals familiar with the detection and investigation of Medicaid fraud and abuse is always at a premium.

IntegrityM understands that Medicaid fraud and abuse can quite frequently result in elder abuse and neglect, which injures a vulnerable population and compounds the need for increased health care services and funding. Our staff specializes in researching various state Medicaid regulatory guidelines and criminal and administrative statutes to ensure compliance within Medicaid programs. Our staff has years of experience performing Medicaid fraud investigations, establishing and revising investigation processes, and management of a Medicaid Fraud Control Unit (MFCU).

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Medicaid Fraud Detection Services

IntegrityM provides Medicaid fraud detection and investigation services in a wide variety of areas:

  • We provide data analysis and program vulnerability support to state Medicaid agencies
  • Our professionals conduct sophisticated data analysis
  • We coordinate Medicaid investigations with Medicaid Single State Agencies for referral to federal and state law enforcement
  • Our team performs Medicaid data match analysis
  • We conduct provider analysis through background research
  • We conduct confidential criminal history background investigations of Medicaid providers in support of state criminal disqualifying offense provisions
  • Our team performs in depth reviews of Medicaid statutory and regulatory guidelines
  • We provide assistance in reviewing, developing and revising investigation and administrative recovery processes
  • Our products are exceptionally well suited for administrative, civil or criminal follow-up action

Our Approach to Medicaid Fraud Detection is Extremely Effective

IntegrityM assigns managers, senior investigators, data analysts, statisticians, and subject matter experts to each client. Our professionals are all highly skilled and experienced in Medicaid fraud and elder abuse and neglect detection and are assigned as a team to ensure continuity, focus and thorough development of the investigation from start to finish. We maintain constant contact with our clients to ensure that we identify and adapt to their changing needs and to keep our clients apprised of project status and any preliminary findings.

The Medicaid fraud investigation process involves extensive data mining, statistical analysis, regulatory and statutory research, and provider background research to detect potential Medicaid provider fraud schemes and identify any disqualifying offenses or billing instruction violations. This allows for a more efficient and effective Medicaid fraud investigation compared to traditional approaches used by most Medicaid Fraud Control Units (MFCU). Many MFCU’s assign a single investigator and this frequently results in a limited investigation. IntegrityM incorporates the expertise and experience of several specialists into every investigation to ensure a thorough, accurate and professional Medicaid health care fraud detection report.

Our investigations have resulted in the identification of millions of dollars in false claims and have been used to pursue criminal and civil actions, Medicaid health care provider prosecutions, exclusions, and administrative recoupment. We have enjoyed the relationships we have developed with our clients and received repeated requests for additional Medicaid fraud detection and investigation services.

Contact the Specialists at Integrity Management Services

To speak with one of our Medicaid fraud detection team members, call (703) 683-9600 today or click here to contact us online

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