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Subrecipient Monitoring That Survives Single Audit– Part 1 of 2
Effective subrecipient monitoring is essential for any pass-through entity that administers federal funds. To “survive” a Single Audit (the comprehensive annual audit for entities expending significant federal funds), organizations must go beyond minimal oversight. They need a structur...
Subrecipient Monitoring That Survives Single Audit– Part 2 of 2
In continuation of our Subrecipient Monitoring series we continue to explore the remaining Pillars.
Pillar 2 - Verification: Trust But Verify Subrecipient Compliance
Once subawards are made (and risk-tiering is in place), the mantra is “trust but verify.” Verification in subrecipient monit...
Strengthening Medicare Program Integrity: The Power of Deterrence in Combating Fraud, Waste, and Abuse
In the ongoing effort to protect the Medicare program, deterrence stands out as a powerful and cost-effective strategy. While detection and enforcement remain critical, deterrence shifts the focus from reacting to fraud after it occurs to preventing it before it starts. By increasing the perceiv...
Navigating the No Surprises Act: A New Era of Transparency in Healthcare
The No Surprises Act, implemented by the Centers for Medicare & Medicaid Services (CMS), marks a major milestone in protecting patients from unexpected medical bills. This landmark legislation, effective January 1, 2022, addresses long-standing issues related to surprise billing and healthca...
The Fraud Beneath the Surface: Investigating Amniotic Wound Care Claims
The surge in the use of amniotic-derived skin substitutes for chronic wound management, especially among diabetic and elderly patients, has opened the door to significant fraud, waste, and abuse across Medicare, Medicaid, and commercial insurance. With per-unit costs running into thousands of do...
From Policy Gaps to Compliance Confidence: Strengthening Grant Management Under 2 CFR 200
Part 2: Practical Steps to Strengthen Your Compliance Framework
What Effective Policies and Procedures Look Like
Not all written policies are created equal. To satisfy Uniform Guidance requirements and withstand audits, policies and procedures must be:
Comprehensive – Covering all area...
Suspect Payments in Medicare Advantage: Why Transparency Matters
Understanding the context of “Suspect Payments”
In Medicare Advantage, payment practices work best when they are clear, consistent, and aligned with beneficiary needs. Strengthening oversight not only reduces compliance risk but also reinforces trust in an organization’s commitment to d...
From Policy Gaps to Compliance Confidence: Strengthening Grant Management Under 2 CFR 200
Part 1: Why Written Policies and Procedures Matter
The Most Common Federal Grant Audit Finding and How to Avoid It
Federal grants play a vital role in advancing public service, driving innovation, and supporting communities across the United States. Agencies and organizations that receive fe...
The Rise of GLP-1 Fraud in Medicare, Medicaid, and Commercial Insurance: Data Driven Approaches to Investigations
The booming demand for GLP-1 receptor agonists such as Ozempic, Wegovy, and Mounjaro, used for weight loss and Type 2 diabetes, has sparked a surge in fraudulent activity across Medicare, Medicaid, and commercial insurance. From inappropriate prescribing and billing anomalies to falsified diag...
