Using the CIGIE Quality Standards for Inspection and Evaluation

Posted by IntegrityM | | Government 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…

Veterans Affairs Health Care Added to GAO High Risk List

Posted by IntegrityM | | Government Evaluation

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…

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

Posted by IntegrityM | | Audit, Government Evaluation, Integrity, Medicare

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…

Medicaid Encounter Data Problems Continue

Posted by IntegrityM | | Government Evaluation, Medicaid

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…

No Wrong Door LTSS Program Evaluations and Planning

Posted by IntegrityM | | Government Evaluation

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…

Medicaid Dental Fraud, Waste and Abuse Reporting

Posted by IntegrityM | | Audit, Government Evaluation, Medicaid

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…

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

Posted by IntegrityM | | Audit, Government Evaluation

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…

Medicaid Managed Care Audits Pay Off…In the Long Run

Posted by IntegrityM | | Audit, Government Evaluation, Medicare

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…

Evaluations Have Standards Too: An Introduction to Government Evaluation Standards

Posted by IntegrityM | | Government Evaluation

A few years ago, one of our team members served as the masters of ceremonies at a training program for individuals interested in government evaluation. He periodically mentioned the Blue Book in the transitions between the various presenters. Later, during a break, numerous people asked him about this Blue Book. It was a bit surprising….

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