The IntegrityM Blog


Medicaid Health Homes Program Operation

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 more chronic conditions; 1 chronic condition and are at risk for a second; or 1 serious and persistent mental health condition. Chronic conditions include substance […]

Read More

Healthcare Secret Shopping: An Effective Tool for Detecting Fraud and Abuse

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 marketplace with secret shopping – constructing fictitious applicants who should not have received health insurance. The secret shopping applicants provided invalid Social Security information or […]

Read More

Medicaid Encounter Data Problems Continue

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 with capitated managed care reported collecting encounter data from their managed care plans. However; 15 States did not include encounter data in their Medicaid Statistical […]

Read More

Ambulance Billing Fraud and False Claims

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 necessary” under Federal Law. To do this, two specific criteria must be met: The use of other transportation methods is contraindicated by the condition of […]

Read More

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 […]

Read More

...23456

Contact Us

Get Industry Blog Updates Directly to Your Inbox