Medicare Drug Integrity Contractors (MEDICs)

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Established under section 1893 of the Social Security Act, the Medicare Integrity Program (MIP) calls for the Centers for Medicare & Medicaid Services (CMS) to enter into contracts with eligible entities to review provider actions, audit claims, report on overpayments, and reveal issues with Medicare program integrity.

Despite the myriad of Medicare program integrity contractors, few have our level of experience and expertise in analyzing claims across both the Part C and D programs, two significant programs within Medicare.

Integrity Management Services has experts familiar with the unique challenges of the program integrity environment in Medicare Advantage and the Prescription Drug Program. We know how to detect and prevent fraud, waste, and abuse and have an in-depth knowledge of the intricacies of the benefit structures of these two programs. IntegrityM staff has data analysis and subject matter expertise with past experience on both: the Outreach and Education (O&E) Medicare Drug Integrity Contractor (MEDIC) and National Benefit Integrity MEDIC.

To discuss how our Medicare Integrity Contractor (MIC) experience and expertise can benefit your program, contact us at (703) 683-9600 or click here to fill out our online contact form.

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IntegrityM’s MEDIC Expertise

IntegrityM can assist in offering solutions in the following areas:

  • Analyzing Part D drug claims from Prescription Drug Event (PDE) records for outlier identification
  • Developing outreach and educational content for Medicare Advantage and Prescription Drug Program stakeholders, including law enforcement, senior advocacy groups, and plan sponsors
  • Delivering presentation and conference speaker support for Parts C and D stakeholder education
  • Supplying regulatory and legislative subject matter expertise
  • Providing extensive Part C and D knowledge in the areas of program integrity, formulary development, and compliance
  • Creating proactive data analysis algorithms for Medicare Drug Integrity Contractors
  • Performing provider trend identification and growth analysis
  • Reviewing and analyzing provider data for outlier identification
  • Offering Medicare drug integrity expertise

Contact the Medicare Integrity Program Contractors at IntegrityM

To learn how Integrity Management Services can help your organization with Medicare Program Integrity, call (703) 683-9600 or click here to contact us online.

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