Public Health & Community Impact Strengthening Access to Services Through Program Integrity During Autism Acceptance Month we recognize the importance of services like ABA therapy and the critical need to improve access for individuals on the autism spectrum. Key Takeaways April marks Autism Acceptance Month, a time to acknowledge and support individuals on the autism…
Program Integrity & Compliance Strategies to Proactively Address Medicaid Program Integrity Proactive strategies to support state Medicaid leaders, MFCUs, and AGs and enhance program integrity. Key Takeaways Medicaid fraud, waste, and abuse (FWA) pose significant risks to public funds, requiring proactive collaboration among state Medicaid leaders, Medicaid Fraud Control Units (MFCUs), and state attorneys general…
Program integrity & compliance Ensuring Program Integrity in ABA Therapy Learn how we support state efforts to identify fraud, waste, and abuse in high-risk service areas. Key Takeaways Applied Behavior Analysis (ABA) therapy is a vital service for children with autism and other developmental conditions, providing necessary interventions that help improve their quality of life….
Grants, Funding & Federal Programs Enhancing Nutrition Program Integrity to Combat Food Insecurity During National Nutrition Month we recognize the food and nutrition programs run by state agencies. These programs must navigate complex regulatory requirements in order to reach the at-risk populations they are designed to serve. Key Takeaways Food and nutrition programs must meet…
program integrity & Compliance The Case for Program Integrity in Medicaid Managed Care | Part 12 The Benefit/Program Integrity team is pleased to have had the opportunity to bring you the blog post series The Case for Program Integrity (PI) in Medicaid Managed Care and share our insights on PI to combat fraud, waste, and abuse (FWA)…
Program integrity & COmpliance The Case for Program Integrity in Medicaid Managed Care | Part 11 In our previous post on claims denials, we presented issues with the underlying data and other variables that influence effective evaluation of prior authorization (PA) and claim denials. We also discussed a few risks associated with PA and claim denials. In…
Program Integrity & Compliance The Case for Program Integrity in Medicaid Managed Care | Part 10 As we discussed in our previous posts describing the complexity of managed care organization (MCO) subcontractor oversight, we evaluated those intricate relationships and the program integrity (PI) challenges involved. We also presented real-world examples. Here, we dive into prior authorization…
Program integrity & compliance The Case for Program Integrity in Medicaid Managed Care | Part Nine In our previous post on subcontractors, we talked about the nuanced aspects of managing PI and addressing FWA within the realm of managed care organizations (MCOs) and their subcontractors and related entities. Here, the Benefit/Program Integrity (PI) team provides…
Program Integrity & COmpliance The Case for Program Integrity in Medicaid Managed Care | Part Eight In our previous post, the Benefit/Program Integrity team discussed problematic encounter data, how it factors into rate setting and the medical loss ratio, and provided recommendations alongside a case study. In this resource, we address the nuanced aspects of…
Program Integrity & compliance The Case for Program Integrity in Medicaid Managed Care | Part Seven In our previous post on encounter data, we offered recommendations for meeting the challenges of problematic encounter data. In this installment, we present a Case Study from one of our own engagements, in which we helped our client transition from PI…
Program Integrity & Compliance The Case for Program Integrity in Medicaid Managed Care | Part Six Encounter Data Recommendations The Impact of Incorrect or Incomplete Data: In our previous post on encounter data, we discussed how faulty encounter data can affect rate setting and create ongoing program risk. In this post, we offer recommendations for managing potential…
Program Integrity & Compliance The Case for Program Integrity in Medicaid Managed Care | Part Five Encounter Data and Problematic Data The Impact of Incorrect or Incomplete Data: As we discussed in our previous post, the medical loss ratio (MLR) structure may incentivize MCOs against pursuing program integrity (PI) to fight fraud, waste, and abuse (FWA). Here, we detail how faulty…