In regulated industries such as healthcare, identifying errors is only part of the equation. The real question is this: what is the total financial impact across the full population? Statistical extrapolation provides that answer. Statistical extrapolation uses results from a properly selected sample to estimate findings across an entire universe of claims, transactions, or records. When designed…
Statistical Analysis
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 perceived risk of getting caught and reducing opportunities for abuse, deterrence…
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 resources while maintaining statistical integrity when applied properly. This approach…
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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 power of data analytics to transform insights into impactful actions. Join us in shaping the future of healthcare integrity.
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 the collective optimism surrounding this new frontier. The detection and prevention of fraud,…
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 CTO Swathi Young and COO Natasha Williams break down the basics of Data Analytics and COVID-19 to shed light on the role this field plays….
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 has been used with smallpox, Ebola, tuberculosis, and AIDS. So what exactly is contact tracing? It is the process of supporting patients with suspected or…
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 the National Center for Health Statistics (NCHS), part of the US Center for Disease Control and Prevention (CDC).i In a July 2017 report, The U.S….
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 fraud investigators. According to The National Health Expenditure Accounts (NHEA), U.S. health care expenditures rose by 2.8 percent in 2015 accounting for approximately 17.8 percent…
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 can process huge amounts of data from multiple sources and remove much of the human element of potential fraud detection. When we think about these…
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 healthcare data analysis. Using The NPPES Database For Data Matching The Centers for Medicare & Medicaid Services issues a unique identification number called a national…
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 Medicare FFS had an improper payment rate of 12.7 percent, or $45.8 billion. Identifying Medicare overpayments is no easy task. The Medicare program is large…
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 therefore greatly increasing your return on every dollar invested into this process? More results with less time and costs! Manually performing sampling and extrapolation can…
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, or The Generally Accepted Government Auditing Standards, that is used by audit organizations. Evaluation work does not have a well-known equivalent and organizations are often…
No Wrong Door LTSS Program Evaluations and Planning
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 overseen by the Administration for Community Living, the Centers for Medicare & Medicaid Services, and the Veterans Health Administration. Without NWD, finding the right…
