UPICs are coming: Will you be ready?
Currently, the Centers for Medicare & Medicaid Services (CMS) use separate Medicare and Medicaid integrity contractors to predict, detect, prevent,…
RAC Program Paused by CMS
The Centers for Medicare & Medicaid Services (CMS) announced a pause in the Medicare Recovery Audit Contractor (RAC) Program until…
Medicaid vs. Medicare Claims Audit Appeals: A Road Less Clear
In recent years the enforcement climate has become harsher than ever before as more and more providers experience significant recovery…
CMS Issues Medicare Advantage and Medicare Prescription Drug Benefit Programs Proposed Rule
The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule with comment period, which will strengthen protections,…
Challenging Overpayment Extrapolations: Statistical Considerations
The government has recovered a record-breaking $10.7 billion in recoveries of health care fraud in the last three years, and contractor reform…
OIG’s Updated Provider Self-Disclosure Protocol: Sampling and Overpayment Extrapolation
On April 17, 2013, the US Department of Health and Human Services (HHS) Office of the Inspector General (OIG) released an Updated OIG’s…
GAO Releases a Report on Data Analytics.
A report from the United States Government Accountability Office (GAO) discussed methods in which oversight and law enforcement agencies use…
The Benefits of Data Mining in Healthcare: The Future Has Arrived
The field of healthcare compliance is in the midst of a sea change leading to wide use of healthcare data mining and…
Confidence and Precision in Claims Audits: Quality of the Estimate
The contractor reform in health care brought a consolidation of Medicare contractors and new contractors, as exemplified by the Medicare…
Why OIG RAT-STATS and Sampling are Hot
The Best Strategy for Health Care Entities Is One of Proactive Preparedness The Centers for Medicare & Medicaid (CMS) are…
OIG RAT-STATS: Response Strategies to Government Audits
The Centers for Medicare and Medicaid (CMS) are now combating provider fraud, waste, and abuse through nationally coordinated strategies and…