The IntegrityM Blog


Inappropriate Medicare Payments for Chiropractic Services More Common than Other Services

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 medical necessity. OIG concluded virtually all payments the provider received were unallowable. Why were all payments not identified as unallowable? OIG used a sample and […]

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  • Author: IntegrityM
  • Date: July 29, 2015
  • Category:

Electronic Health Record Challenges: A Look at EHR Fraud, Security Issues, & Adoption Barriers

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 health records (EHRs). EHRs offer tools to mitigate human error, be a medium to share personal medical records securely across the country, establish electronic communications […]

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  • Author: IntegrityM
  • Date: July 10, 2015
  • Category:

Medicaid Dental Fraud, Waste and Abuse Reporting

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, and California.  These reports are just one part of OIG’s multi-faceted approach to combat dental fraud.  The agency also has ongoing audits of Medicaid dental […]

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Identifying Fraud is Not Always Easy: Analyzing State Medicaid Fraud Control Unit Reports

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 Units. For those of you unfamiliar with Medicaid Fraud Control Units (MFCU), the MFCUs are: single identifiable entities of State government that conduct a Statewide […]

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Medicaid Managed Care Audits Pay Off…In the Long Run

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 state and federal program integrity officials we interviewed told us that they did not closely examine Medicaid managed care payments, but instead primarily focused their […]

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