Experienced Medicare Fraud and Abuse Prevention, Detection and Reporting Services

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Medicare is the largest national health care program and requires billions of dollars in funding annually. The financial burden to state and federal governments to maintain the health care services covered by this program continues to increase at an alarming rate. A substantial portion of that increase has been attributed by US legislators to Medicare fraud and abuse.

Efforts to detect, prevent and eliminate Medicare fraud, waste, and abuse is an ongoing effort by federal legislature and law enforcement agencies. An assortment of federal programs aimed at curbing the flow of funds lost to Medicare fraud have been implemented and IntegrityM has specialized staff which possess the skills to assist in that endeavor.

IntegrityM is staffed with highly experienced and seasoned senior investigators, inspectors, statisticians, data analysts, and subject matter experts who possess decades of experience conducting criminal and civil investigations with agencies such as: the Federal Bureau of Investigation, US Department of Health and Human Services, Offices of Inspector General, and with contracted oversight agencies such as Zone Program Integrity Contractors (ZPIC) and Program Security Contractors (PSC).

Our staff has conducted, managed and provided oversight to Medicare fraud detection and investigation efforts at all levels to identify matters of regulatory and statutory noncompliance, and to enforcing benefits integrity initiatives to prevent the loss of Medicare funds to fraud schemes like the upcoding of Common Procedure and Terminology (CPT) service codes, duplicate billing, or the unbundling of services to achieve a higher reimbursement rate for Medicare paid services. Our staff has been involved in the implementation and use of analytical predictive modeling database programs like Medicare’s Fraud Prevention System (FPS) and Fraud Investigation Database (FID). Our highly specialized staff has experience in coordinating Medicare provider suspension or exclusion action with the Center for Medicare and Medicaid Services (CMS) and is prepared to for any changes implemented by Medicare.

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Medicare Fraud and Abuse Detection and Investigation Services

Integrity Management Services provides Medicare fraud detection, investigation, and abuse prevention services in a wide variety of areas:

  • We provide support to several ZPICs and PSCs as they conduct Medicare health care fraud investigations
  • Our staff of senior analysts and statisticians conducts sophisticated data analysis
  • We coordinate Medicare investigations with a variety of clients and refer violations
  • Our team performs Medicare-Medicaid data match analysis
  • We support and conduct provider analysis background research
  • We conduct confidential criminal history background investigations on Medicare providers
  • Our team performs in depth reviews of Medicare statutory and regulatory compliance requirements to detect fraud or program mismanagement
  • We provide assistance in developing and revising investigative and administrative repayment processes and reports
  • Our investigative products are exceptionally well suited for administrative, civil or criminal follow-up action

Our Approach to Medicare Fraud Detection and Investigation is Highly Effective

Integrity M conducts Medicare fraud detection investigations in a manner which pulls together the experience and capabilities of our specialists. A team approach to any of our projects is paramount and involves managers, senior investigators, senior data analysts and statisticians and subject matter experts who are all highly skilled and experienced in Medicare fraud prevention. A team of specialists is assigned to specific investigations to develop an intimate knowledge and coordinated all aspects of the project.

The Medicare fraud investigation process incorporates data mining, statistical analysis, regulatory and statutory research, and provider background research to detect any potential fraud schemes, provider disqualifiers, or standards violations. This method has proven to be a more efficient and effective approach than the one commonly used by investigative and data analytics agencies. While they typically depend on a single lead investigator or analyst, IntegrityM incorporates the expertise and experience of our specialists into all of our investigations at all levels of a project to ensure a thorough, accurate and professional health care fraud report.

Our investigations have identified the overpayment of millions of dollars in Medicare funds resulting from false claims and have been used to pursue criminal and civil actions, health care provider suspensions, and administrative recoupment. IntegrityM continually receives laudatory comments from our clients regarding our product and repeated requests for additional Medicare fraud detection services which attests to our diligence, professionalism and competence.

Contact the Specialists at Integrity Management Services

If you would like to speak with a specialist regarding our Medicare fraud and abuse prevention, detection, and reporting services, call (703) 683-9600 today. You can also click here to contact us online.

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