Medicare’s $60 Billion Challenge

Medicare loses an estimated $60 billion annually to fraud, waste, and abuse (FWA), a serious drain on critical health resources that directly affects the care and well-being of millions of…

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…

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)…

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…

Alexandria, VA – January 23, 2025 – Integrity Management Services (IntegrityM), a leading provider of compliance management and program integrity solutions, is pleased to announce that it has been awarded…

We offer solutions as a trusted & reliable program integrity partner. With 30+ years of proven expertise, we deliver successful results for government agencies like CMS and the commercial sector….

News on an addiction treatment facility operator caught paying $2.9M in kickbacks underscores the urgent need for robust fraud prevention. The fight for healthcare integrity continues at IntegrityM. Here, we unlock the…

Last week, the U.S. Department of Justice presented several cases highlighting how “the department’s investment in data analytics produces outsized returns” in its fight against healthcare fraud. Learn more about the…

Alexandria, Virginia, June 21, 2024 – Integrity Management Services has been awarded a Top Workplaces 2024 honor by the Washington Post. This recognition is based solely on employee feedback gathered…

Alexandria, VA, November 2, 2023 – Integrity Management Services (IntegrityM) is thrilled to announce the launch of ASEPro™, a technologically intelligent, user-friendly, and scalable solution that performs accurate and swift…

Alexandria, VA, October 26, 2023 – Integrity Management Services (IntegrityM) is proud and honored to announce that it has been named a winner of the highly esteemed 2023 Moxie Award….

Alexandria, VA, September 11, 2023 – Integrity Management Services (IntegrityM) is honored and pleased to announce that it has been recognized as an honoree on the prestigious OrangeSlices’ 2024 Elev8…

Alexandria, VA, June 27, 2023 – Integrity Management Services (IntegrityM) is honored and excited to announce that it has been named a finalist in the highly esteemed 2023 Moxie Award….

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…

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…

FOR IMMEDIATE RELEASE – Integrity Management Services, Inc. (IntegrityM) has just been recognized as being among OrangeSlices’ most recent Elev8 GovCon honorees. The Federal GovCon sector continues to be one…

The National Science Foundation (NSF), Office of Budget, Finance and Award Management (BFA) awarded Integrity Management Services, Inc. (IntegrityM), a competitive Woman-Owned Small Business set-aside federal prime contract. NSF is…

IntegrityM has been named one of DCA Live’s “Red Hot GovCon Companies” for 2022. This list recognizes the Washington D.C. region’s “fastest growing and most exciting companies” within the federal…

IntegrityM today announced that President and CEO Nisha Shajahan was selected as a finalist for the 14th Annual Small and Emerging Contractors Advisory Forum (SECAF) Awards. Winners will be announced…

For the second time, IntegrityM has been recognized at the National Small Business Federal Contracting Summit with the U.S. Women’s Chamber of Commerce (USWCC) “Stellar” Award. This category recognizes “exceptional…

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…

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…

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…

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…

IntegrityM’s C.O.D.A. (COVID-19 Outreach Digital Assistant) was selected as a winner of a 2021 Innovation Award by ACT-IAC, a non-profit recognized as the premier public-private partner for the government tech…

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…

IntegrityM has been named a finalist for the 2021 Moxie Awards, which is an annual award program recognizing companies that have demonstrated boldness and innovation as an integral part of…

ALEXANDRIA, VA. — IntegrityM was recently awarded the addition of Information Technology SIN 54151S for IT Professional Services and SIN 54151HEAL for Health IT Services to our existing GSA Multiple Award…

ALEXANDRIA, VA: On January 28, 2021, Women in Technology (WIT) named IntegrityM Chief Technology Officer, Swathi Young as a finalist for the WIT Leadership Awards “STEM Leadership” category. This annual…

Author: Jennifer Tryder, RHIA, CHC, Audit Program Director, IntegrityM An audit guide is a documented step-by-step method for conducting an audit focusing on objectives and scope. An audit guide supports…

ALEXANDRIA, VA, October 26, 2020 — Intara Talent Solutions, a new niche talent agency catering to healthcare investigations and program integrity, announced their official launch this month. Intara Talent Solutions offers commercial and federal…

A well-known truism from philosopher Aristotle, is: “We are what we repeatedly do. Excellence is not an act, but a habit.” When running a small business, your world is governed…

Author: Natasha Williams, Chief Operating Officer, IntegrityM A well-known truism from philosopher Aristotle, is: “We are what we repeatedly do. Excellence is not an act, but a habit.” When running…

Data Analytics is an indispensable tool being used in COVID-19 recovery efforts. Many of us take for granted that this is being used, but are not quite sure how.  IntegrityM…

What is Contact Tracing? Contact Tracing is not new.  It has been used to control infectious disease for decades. Contact Tracing is one of the oldest public health tactics and…

Did you know that nurses don’t just defend public health through direct patient care – they’re also crucial team members on the front lines fighting fraud, waste and abuse? Their…

Fraud in Medicare Advantage often operates under the radar, but relationships or subtle patterns can reveal its presence. To uphold program integrity, look beyond obvious data anomalies and consider these…

The U.S. Department of Veterans Affairs (VA) Veterans Health Administration (VHA) has awarded a 10-year, $1 billion indefinite delivery/indefinite quantity (IDIQ) contract to AptiveHTG to provide healthcare and professional services…

Artificial Intelligence (AI) applications are at our fingertips every day – think Siri, Alexa, Netflix recommendations, and spam filters. Most AI algorithms use large quantities of data to learn about…

IntegrityM is a wholehearted supporter of the current public effort to minimize the spread of COVID-19 through social distancing and self-isolation. We know that while these practices are good for…

Leading Women-Owned Small Business IntegrityM was presented with the U.S. Women’s Chamber of Commerce “Stellar” Award. This category recognizes “exceptional contractors who have shown exemplary growth, quality, and are positioned…

Leading women-owned small business Integrity Management Services, Inc. (IntegrityM), is pleased to announce that Swathi Young has joined the firm as Chief Technology Officer. In this role, Swathi will spearhead…

Integrity Management Services, Inc. (IntegrityM) has been awarded a competitive small business set-aside federal prime contract from the Centers for Medicare & Medicaid Services (CMS), Office of Financial Management, Division…

One good way to measure the effectiveness and efficiency of a Special Investigative Unit (SIU) is to determine its return on investment (ROI). While some companies may conduct routine evaluations…

Working remotely allows people a certain amount of autonomy, but being less engaged with the day-to-day routines and culture of the office can reduce an employee’s productivity and sense of…

IntegrityM is honored to be recently named to the Virginia School Boards Association (VSBA) Business Honor Roll for the work they do in support of Fairfax County Public Schools (FCPS)…

IntegrityM is excited to announce that we’ve been nominated for a Greater Washington Good Business Award in the small business category, presented by the Northern Virginia Chamber of Commerce.These awards…

A well-written healthcare fraud investigative report can help to identify and prevent improper payments – having a significant impact on individuals and organizations, including federal and state government agencies. The…

ALEXANDRIA, VA — Integrity Management Services, Inc. (IntegrityM), an Alexandria-based, women-owned small business, is proud to reach an exciting milestone this year – celebrating 10 years supporting program integrity efforts…

When accidents or weather delays cause traffic to stall for miles, it’s easy to understand the appeal of working remotely. According to FlexJobs, more than 3.9 million Americans reported working…

According to the National Eye Institute, by 2050, the estimated number of people with age-related macular degeneration (AMD) in the United States is expected to more than double from 2.07…

IntegrityM to Present and Exhibit at HCCA Managed Care Compliance Conference IntegrityM is pleased to announce that it will present at the Health Care Compliance Association’s 2019 Managed Care Compliance…

Unless you’re living under a rock, you probably heard the news — Amazon is expanding and will make their new home (or part of it, rather) in what will now…

There are times, despite your best efforts, things may go wrong, impacting customer satisfaction. When conflict or uncomfortable situations arise, act swiftly to reduce tension and begin repairing your customer…

Most businesses have two basic goals: to maintain profitability and to grow revenue. As simple as these goals are, some companies are so focused on growing new business pursuits, they tend…

IntegrityM President and CEO Named Washington Business Journal 40 Under 40 Honoree Integrity Management Services Inc. (IntegrityM) President and CEO, Nisha Shajahan, has been named a Washington Business Journal (WBJ)…

In 2016, there were more than 63,600 drug overdose deaths in the United States — this is more than three times the rate in 1999 according to a report from…

IntegrityM Honored for Excellence in the Government Contracting Industry Integrity Management Services, Inc. (IntegrityM) is honored to announce it was selected as the winner of The Small and Emerging Contractors…

IntegrityM Honored for Excellence in the Government Contracting Industry IntegrityM today announced that it was selected as a finalist for the 10th Annual Small and Emerging Contractors Advisory Forum (SECAF) Awards….

Medical coders often serve as the gatekeepers of compliance and quality for healthcare organizations. Errors and mistakes can result in denials, delayed payments, or even put an organization at risk…

Integrity Management Services Inc. (IntegrityM) is honored to announce our President/CEO, Nisha Shajahan, has been selected as a finalist for the 19th Annual Women In Technology (WIT) Leadership Awards. Annually,…

Integrity Management Services Inc. (IntegrityM) is pleased to announce that Jennifer Tryder, Program Director, and John Hapchuk, Healthcare Regulatory Advisor, have been selected to deliver their presentation at the Health…

Fighting fraud, waste, and abuse in health care programs is labor intensive often requiring multiple experts including but not limited to data analysts and statisticians, certified coders, clinicians, auditors and…

Integrity Management Services, Inc. (IntegrityM) has been awarded a competitive total set-aside prime Federal contract from Health Resources and Services Administration (HRSA) under the Department of Health and Human Services…

Integrity Management Services Inc. (IntegrityM) is pleased to announce its participation as an exhibitor at the NHCAA Institute for Health Care Fraud Prevention Anti-Fraud Expo held in conjunction with the…

The key to successfully harnessing the power of data in healthcare is to analyze, interpret, and share the results in a way that is meaningful and effective for decision makers….

Integrity Management Services, Inc. (IntegrityM) is pleased to announce that Didem Egemen, statistician, has been selected to deliver her abstract at the INFORMS 2017 Annual Meeting. INFORMS — the Institute…

With over 2 billion Medicare claims available for analysis since 2006, the term “Big Data” has no better application than in the health care industry. The opportunity for meaningful analyses…

Organizations across the health care program integrity industry are using analytic solutions for fraud detection and prevention that intake and analyze data to signal the threat of fraud. These solutions…

Integrity Management Services Inc. (IntegrityM) is pleased to announce its participation as an exhibitor at the 33rd Annual National Association for Medicaid Program Integrity (NAMPI) 2017 Conference in Miami, Florida….

Healthcare Fraud Investigators provide a valuable resource in the fraud analysis process. They perform in-depth evaluation and analysis of potential fraud cases and requests for information using claims and other…

Sarah Langford of Integrity Management Services, Inc. (IntegrityM) will present an overview of bias in fraud detection and prevention systems, providing insight on the points at which bias can be…

Telehealth is expanding rapidly and transforming healthcare. According to the Medicare Payment Advisory Commission, the number of telehealth visits grew by over 500 percent from 2008 to 2014. Additionally, many…

Integrity Management Services, Inc. (IntegrityM) is pleased to announce its achievement of International Organization for Standardization (ISO) 9001:2015 certification. ISO 9001:2015 certification establishes the criteria for quality management principles, including…

IntegrityM is honored to announce that it was selected as the 2017 Small Business Administration (SBA) Washington Metropolitan Area District Office (WMADO) Small Business Subcontractor of the Year. SBA’s small…

Federally Qualified Health Centers (FQHCs) provide primary care services to millions of people each year with limited access to care. Medicare Part B has covered FQHC services at certified FQHCs…

Integrity Management Services, Inc. (IntegrityM) is pleased to announce it has been appraised at level 3 of the CMMI Institute’s Capability Maturity Model Integration (CMMI)®. The appraisal was performed by…

IntegrityM Lauded for its Success in the Government Contracting Industry IntegrityM today announced that it was selected as a finalist for the 9th Annual Small and Emerging Contractors Advisory Forum…

When performed correctly, statistically valid sampling and extrapolation can be a powerful tool, allowing for the effective use of audit and investigative resources. Statistically valid sampling allows organizations to collect…

Constructing a solid medical review team requires the successful networking, staffing, management, and ongoing support of the clinicians and the support team. The Significance of a Solid Team Medical review…

Healthcare fraud very seldom happens in a vacuum. Therefore, data matching — the ability to identify, match, and merge records that correspond to the same entities — is essential to…

Medicare and other health plans have a variety of tools at their disposal to prevent and identify improper payments. The tools can differ depending on whether they are applied before…

In fiscal year (FY) 2015, the error rate for the Medicare fee-for-service (FFS) program was 12.1 percent, or $43.3 billion. This result is an improvement over FY 2014, in which…

Paulo Macedo and Sewit Araia of Integrity Management Services (IntegrityM) will present an overview of data analytics methods used in fraud detection, giving users a greater confidence to identify patterns…

Each year, the Federal Government makes billions of dollars in improper payments. Improper payments can take the form of overpayments, payments to the wrong person, or payments for the wrong…

What if there was a healthcare data analysis solution that could save you a significant amount of time in the sampling and extrapolation process, resulting in substantial cost savings, and…

Integrity Management Services, Inc. (IntegrityM) is proud to announce we have received our SWaM Certification from the Commonwealth of Virginia Department of Minority Business Enterprise (DMBE).  The Small, Women-owned, and…

The Affordable Care Act directed the Secretary of Health and Human Services to establish criteria for certification of qualified health plans, to include (1) ensuring a sufficient choice of providers…

IntegrityM is proud to announce that, out of more than 100 submissions, they have been selected as a Finalist for the 2016 Federal Health IT Challenge. The 2016 Federal Health IT Challenge…

IntegrityM is pleased to announce promotions within its executive team. “This is an incredibly exciting time for IntegrityM,” said Nisha Shajahan, President and CEO, IntegrityM. “I’m thrilled that we had…

Integrity Management Services, Inc. (IntegrityM) is happy to announce that Dr. Paulo Macedo has been selected to speak at the 2016 SAS Global Forum in Las Vegas from April 18…

Integrity Management Services, Inc. – IntegrityM, a leading provider of program integrity and compliance solutions to federal and state agencies, is excited to announce that it is now a Woman…

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,…

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…

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…

International Fraud Awareness Week kicks off Nov. 15, 2015 worldwide [Alexandria, Virginia]– Fraud costs organizations worldwide an estimated 5 percent of their annual revenues, according to a study conducted by…

On September 25, 2015, the Centers for Medicare & Medicaid Services (CMS) awarded the new Trusted Third Party (TTP) contract to Computer Sciences Corporation (CSC), an industry leader of next-generation…

A U.S. Department of Health and Human Services Office of Inspector General (OIG) report from October, 2012 offers some interesting insights into the usefulness of criminal background checks for nurse…

Section 2703 of the Affordable Care Act created an optional Medicaid State Plan benefit – Health Homes – to coordinate care for individuals who have Medicaid and have: 2 or…

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…

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…

Medicare ambulance claims, just like everything involved with Medicare, must meet certain requirements to be considered valid ambulance transport claims. The main factor is the transport must be considered “medically…

The No Wrong Door (NWD) system is intended to streamline access to long-term services and support (LTSS) options for older adults and individuals living with disabilities. NWD grants are collectively…

In May 2015, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a report finding all claims for the provider under review failed to support…

Since the late 20th to early 21st century, reports such as “To Err is Human” by the Institute of Medicine have been published and have advocated the adoption of electronic…

OIG has just released the last in a series of four Medicaid dental fraud reports.  The reports identified dentists and orthodontists with questionable billing practices in New York, Louisiana, Indiana,…

The U.S. Department of Health and Human Services Office of Inspector General (OIG) recently released a data chart offering fiscal year (FY) 2014 statistical data for the Medicaid Fraud Control…

In May 2014, the Government Accountability Office (GAO) released a report calling for increased oversight of Medicaid managed care spending (the report can be found here). GAO reported that “Most…

The purpose of this paper is to offer a technique to more clearly and fully describe healthcare errors detected in audits, which can lead to improved return on investment (ROI)…

One of the key goals of healthcare data mining is to reduce false positives.  In health care fraud data mining, a false positive occurs when your model identifies a provider…

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued an audit report to the Centers for Medicare & Medicaid Services (CMS) in February 2015…

A few years ago, one of our team members served as the masters of ceremonies at a training program for individuals interested in government evaluation. He periodically mentioned the Blue…

On March 6, 2015, the U.S. Department of Health and Human Services Office of Inspector General (OIG) released the latest in a series of reports looking at hospitals’ billing and…