The IntegrityM Blog


Veterans Affairs Health Care Added to GAO High Risk List

In 2015, the Veterans Affairs (VA) Health Care achieved a distinction held by two other large Federal health care programs – Medicare and Medicaid – that of being designated a Government Accountability Office (GAO) high risk program. VA Health Care was added to the GAO High Risk List in response to its problems providing adequate […]

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OIG Work Plan for 2016 Highlights New Program Evaluations and Oversight

The HHS OIG released its Work Plan for FY 2016 on November 2nd. The Work Plan outlines audits, evaluations, and other activities OIG is conducting or plans to conduct in the coming fiscal year. Much of the planned work for FY 2016 focuses on cut and dry payment reviews with the goal of identifying and […]

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How Effective are Criminal Background Checks Really?

A U.S. Department of Health and Human Services Office of Inspector General (OIG) report from October, 2012 offers some interesting insights into the usefulness of criminal background checks for nurse aides. To get to these insights, some setup is needed. Nurse aides work in long-term-care facilities. To work as a nurse aide, individuals must complete […]

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  • Author: IntegrityM
  • Date: October 14, 2015
  • Category:

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 […]

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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 […]

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