Program Integrity and Compliance

Medicaid agencies like yours are charged with ensuring the integrity of the Medicaid program. For Federal agencies that means performing post-payment audits of the claims payment system, while state plans must incorporate program integrity reviews and data mining across all provider types, including managed care plans.

The COVID-19 pandemic brought additional challenges for states, including paused federal and state program integrity requirements and new health care delivery methods like telehealth.

Our solutions are highly innovative, but it’s our team of experts, with decades of experience collaborating with state Medicaid agencies, who set us apart. As long-standing partners with our clients, we function as a secondary arm of your program integrity unit, working with you to identify patterns, develop new responsive algorithms, shift future outcomes, and provide ongoing training to agency staff.

1. 1

   We help our clients recover millions of dollars in costs savings by rooting out and safeguarding against Medicaid fraud, waste, and abuse.

2. 2

   Our approaches enhance states’ ability to deliver and sustain quality care to Medicaid members.

3. 3

   With a customized program integrity component, our data analytics solution identifies problematic payment activities often overlooked by large-scale software solutions.