Detecting and Preventing Fraud, Waste, and Abuse in Health Care Organizations

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Health care programs are adversely impacted by fraud, waste, and abuse committed either intentionally or through mismanagement on the part of healthcare providers. Efforts to combat fraud, waste and abuse in health care is reliant on detection through data analysis, investigations, and the reporting of suspect activities by means of compliance hotlines or websites.

Although layers of program oversight are in place, often the overall effectiveness of those processes is hindered by inexperienced staff. Inadequate training and lack of experience detecting, reporting and appropriately responding to suspect activities put billions of health care service dollars at risk.

IntegrityM is staffed with highly motivated, professional, senior-level data analysts, statisticians, and investigators. Our staff is at the forefront of the health care management field with years of experience conducting healthcare claims analysis, criminal and civil health care fraud investigations, prosecution and administrative recovery referrals, and detecting regulatory and statutory noncompliance.

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Health Care Fraud, Waste, and Abuse Services

Integrity Management Services provides consulting and support services in a wide variety of areas:

  • We provide daily support to health care program administrators in the detection of health care fraud waste and abuse
  • We perform sophisticated data analysis
  • We coordinate with law enforcement and refer violations
  • We conduct provider analysis through background research
  • We perform confidential criminal history background investigations of health care providers
  • We perform in depth reviews of statutory and regulatory compliance
  • We develop and revise processes and reports to support our clients in the furtherance of their fraud, waste and abuse prevention efforts

Our Proven Approach to Detecting and Preventing Health Care Fraud, Waste and Abuse

The first step of our prevention and detection services involves the assignment of a manager, senior investigator, data analyst or statistician, and subject matter expert to each project. Our skilled and highly experienced specialists are assigned to specific projects to ensure an intimate knowledge of their assignment from start to finish.

Conventional analysis or audit approaches can often result in a very limited and incomplete report. At IntegrityM, we incorporate the expertise and experience of our specialists into all of our investigations to ensure thorough, accurate and professional health care fraud reporting.

Our detection, analysis, and evaluation process involves extensive data mining, statistical analysis, regulatory and statutory research, and an in depth provider background review to detect any past or potential fraud involvement. We will find any offenses that violate state and federal statutes or operating standards.

Our services have resulted in the identification of millions of dollars in false or erroneous claims and have been used in criminal and civil follow up actions, health care provider suspensions and administrative recoveries. The positive feedback from our clients and their repeated requests for additional services attests to our competence and professionalism.

Contact the Specialists at Integrity Management Services

If you would like to speak with a specialist regarding fraud, waste and abuse in health care, call (703) 683-9600 today. You can also click here to contact us online

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