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)…
Investigations
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…
“Outsized Returns” in Combating Healthcare Fraud!
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 2024…
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…
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…
Avoid “Investigative Leakage” for More Effective and Efficient Healthcare Fraud Investigations
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…
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…
Using the CIGIE Quality Standards for Inspection and Evaluation
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,…
Evaluations Have Standards Too: An Introduction to Government Evaluation Standards
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…
