Medicare Program Integrity Services
Medicare program integrity is essential to maintaining accurate payments, ensuring compliance, and safeguarding federal resources in a highly regulated healthcare landscape. Our expertise and integrated approach empower federal agencies to address vulnerabilities, enhance oversight, and align program operations with CMS standards.
Supporting Oversight, Compliance, and Payment Accuracy Across Medicare Programs
Medicare program integrity requires a coordinated approach to ensure payments are accurate, services are medically necessary, and federal funds are protected. As Medicare payment models continue to evolve, federal agencies need experienced partners who can provide objective analysis, strengthen oversight activities, and support compliance with CMS requirements.
Myers & Stauffer supports federal agencies responsible for administering and overseeing Medicare programs through independent program integrity services spanning Medicare fee-for-service, Medicare Advantage, and Medicare Part D. Our multidisciplinary teams combine clinical, coding, financial, and data analytics expertise to deliver defensible, actionable results that strengthen program oversight and accountability.
Strengthening Medicare Program Integrity
Myers and Stauffer helps federal agencies improve Medicare program integrity through medical review, payment validation, advanced analytics, fraud and abuse identification, and operational oversight. Our independent, government-focused approach helps agencies protect program resources, improve payment accuracy, and maintain compliance across the Medicare program.
We perform medical review and payment integrity activities to evaluate provider compliance, validate payments, and identify potential improper payments across Medicare programs.
Our services include:
By combining clinical and reimbursement expertise, we help agencies improve payment accuracy while supporting consistent application of Medicare coverage and billing requirements.
Data analytics are central to effective Medicare program integrity. We analyze Medicare claims and related data to identify billing trends, prioritize review activities, and detect potential vulnerabilities before they become larger program risks.
Our analytical capabilities support:
These insights help agencies focus resources on the areas of greatest risk while strengthening ongoing monitoring efforts.
As Medicare Advantage and Part D enrollment continues to grow, effective oversight requires specialized knowledge of evolving payment models, operational requirements, and emerging program risks.
We support program integrity efforts through:
Our experience helps agencies strengthen oversight while promoting accountability across Medicare Advantage and Part D programs.
Protecting Medicare requires proactive identification of potential fraud, waste, and abuse. We support government-led program integrity initiatives through targeted reviews and analytical techniques designed to identify suspicious billing patterns and emerging vulnerabilities.
Our experience includes work performed within CMS program integrity environments and contractor-led oversight models, including Unified Program Integrity Contractors (UPICs) and Medicare Drug Integrity Contractor (MEDIC) activities.
Effective program integrity depends on well-designed operational processes and consistent oversight practices. We help agencies strengthen the systems that support audit, review, and compliance activities.
Our support includes:
These capabilities help agencies improve consistency, transparency, and operational effectiveness across program integrity functions.
Why Agencies Choose Myers & Stauffer
Our Medicare program integrity services are built on decades of experience supporting government oversight initiatives. We understand the complexities of Medicare payment systems, contractor oversight models, and evolving CMS program integrity priorities. Our multidisciplinary teams provide:
Connection to Broader Program Integrity
Medicare program integrity frequently intersects with Medicaid and other health and human services programs, particularly where providers, payment models, and dual-eligible populations overlap. Our broader Program Integrity & Oversight services help agencies coordinate oversight activities, identify cross-program risks, and strengthen accountability across government-funded programs.
Connect With Our Team
Partner with experts who understand the complexities of health and human services programs. Let us guide your organization through the industry’s unique challenges and opportunities.
Jenna Hall, CPA, CFE
Member
Email: jhall@mslc.com
Phone Number: 919-829-7430
Andy Ranck, CPA
Member
Email: aranck@mslc.com
Phone Number: 410-581-4555
In the Words of our Clients…
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