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…
Data Analytics
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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….
Combating Fraud with Data Analytics: The Fight for Healthcare Fraud Continues
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…
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…
What you need to know about the 2021 Open Payments Program Expansion
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…
Four Schemes to be Wary of Amid Soaring COVID-19 Fraud Reports
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…
Data Analytics & COVID-19 Recovery: A Math-Free Explanation
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…
Contact Tracing 101: 5 Quick Facts on Our Most Effective Tool to #flattenthecurve
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…
Signs of Fraud in Payment Arrangements!
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…
Comparative Billing Reports: A Valuable Tool for Outreach and Education
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…
So You’ve Detected an Outlier… Now What?
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…
Statistical Bias in Health Care Fraud Detection and Prevention Systems
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…
Data Matching Techniques For Healthcare Fraud Detection
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 Overpayment Recovery: Identifying and Calculating Overpayments
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…
GLȲD(Σ): Revolutionizing Healthcare Data and Statistical Analysis
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…
