IntegrityM Blog

News of the Executive Vice President of an insurance brokerage firm pleading guilty in a $133.9M Affordable Care Act fraud scheme underscores the urgent need for strong fraud prevention. The FBI, HHS-OIG, and IRS-CI are investigating the case. Learn more: Press Release. The fight for heal...

Medicare Advantage (MA) has reshaped healthcare coverage for beneficiaries, offering comprehensive benefits through private insurers. However, the program's expansion has also introduced complex challenges, notably fraud, waste, and abuse (FWA) that threaten its integrity and the well-being ...

Did you know that Medicare and Medicaid, established in 1965 under President Lyndon B. Johnson, have profoundly influenced public health in the United States? Initially designed to provide health insurance to seniors and low-income individuals, these programs have expanded access to care, reduce...

The U.S. government won over $5 billion in healthcare fraud cases in 2021 according to the HHS Annual Report. That’s a huge number—but it only covers the dollar amount of fraud successfully found through investigations and reporting. Combatting the billions of dollars in fraud each year is the w...

The signing of the Inflation Reduction Act in August of 2022 brought some immediate relief for Americans with Medicare prescription drug coverage and will continue to drastically impact drug prices as implementation continues.  Already in effect as of January 2023: a $35 cap per month on...

Author: Natasha Williams, Chief Operating Officer There is a wave of excitement in the industry surrounding artificial intelligence (AI), and not without reason. AI, with its ability to synthesize massive quantities of information at lightning speed, promises limitless possibility. I share in...

Technology doesn’t have to be complicated. IntegrityM CTO Swathi Young’s #TechTalk series is designed to provide quick, digestible explanations of the latest trends in healthcare technology and innovation so that you can stay ahead of the game before you finish your morning coffee. The Agile ...

IntegrityM strongly encourages new ‘covered recipients’ to familiarize themselves with the Open Payments system, so that they can have a successful experience in CY2022. Open Payments Program Background: Under the Physician Payment Sunshine Act (Section 6002 of the Patient Protection and...

Technology doesn’t have to be complicated. IntegrityM CTO Swathi Young’s #TechTalk series is designed to provide quick, digestible explanations of the latest trends in healthcare technology and innovation so that you can stay ahead of the game before you finish your morning coffee. Artificia...

While combating fraud, waste, and abuse is a federal initiative upheld by each state, administrators achieve this through various means. Some state OIGs report that their work is primarily focused on beneficiary fraud, while some work in both beneficiary and provider fraud.  Furthermore, st...