Projects in Program Integrity/Fraud, Waste, and Abuse
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If your agency or organization is charged with oversight duties, let Insight help document and implement effective strategies for ensuring accurate payments for covered program services to reduce fraud, waste, and abuse. We have years of experience conducting assessments of proper estimation methods to calculate payment errors and assess payment accuracy. Partner with Insight for better solutions.
Key projects are as follows:
| Centers for Medicare and Medicaid Services (CMS) |
- Evaluated the Recovery Audit Contractors (RACs) for the Medicare Provider Community to ensure that Medicare providers received the correct payments while incurring minimal burden on the provider community. In partnership with Econometrica, Inc., we developed an ongoing process for sampling claims and estimating monthly RAC payment error.
- Conducted the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) and the calculation of Medicare Part C Composite Payment Error. In partnership with Deloitte, Inc., we developed the sample design, weighting, and estimation procedures for the 2007 and 2008 national and targeted samples of enrollees, and wrote recommendations for calculation of the Medicaid Status Payment Error Rate.
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| Health Resources and Services Administration (HRSA) |
- Evaluated the effectiveness of databases designed to protect the public from health care practitioners, providers, and suppliers with a history of malpractice, adverse actions, fraud, and abuse.
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