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…

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…

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…

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…

Improving Healthcare Error Reporting In Healthcare Audits

The purpose of this paper is to offer a technique to more clearly and fully describe healthcare errors detected in audits, which can lead to improved return on investment (ROI) for healthcare audits. A clear and complete description of all identified errors in a healthcare audit report will help assure that all readers of the…

Certifications and Memberships

U.S. Women's Chamber of Commerce Small, Women and Minority Owned CMMISVC-3 GSA Contract HolderPRI Registrar Member ASA

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