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...
Highlighting Public Tools That Advance Medicaid Transparency and Oversight
Let’s talk about…the power of public data tools.
Public data dashboards are vital tools for strengthening accountability in healthcare programs. In Medicare and Medicaid, they equip beneficiaries, agencies, and policymakers with insight into how services are delivered and how that information...
Advancing Healthcare Claims Technology
IntegrityM partners with AI and machine learning developers to embed clinical, regulatory, and compliance expertise into the design and deployment of healthcare automation tools. As a trusted healthcare partner, we guide the use of AI/ML technologies in medical coding, claims analysis, and ...
What Is Statistical Extrapolation and Why Does It Matter?
Extrapolation is a statistical method used to estimate values for an entire population based on a smaller, randomly selected sample. In healthcare audits, this technique allows auditors to review a manageable subset of claims and project the findings to the full universe, saving time and resour...
Exposing Hidden Risks: A Strategic Approach to FWA in Medicare Advantage
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 ...
Beyond Coverage: How Medicare and Medicaid Transform Public Health
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...
How it Works: Health Insurance Fraud Investigation
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...
How the Inflation Reduction Act will impact Medicare drug prices
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...
Quality Data has to Lead the AI Charge
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...
