Program Integrity Oversight & Compliance
Myers & Stauffer provides program integrity, compliance, audit, and oversight services to federal, state, and local government agencies administering Medicaid, Medicare, public health, and human services programs. We help agencies strengthen payment integrity, eligibility integrity, managed care oversight, fraud, waste, and abuse detection, data analytics, and regulatory compliance through independent, data-driven solutions that improve accountability, safeguard public funds, and support effective program administration across complex government programs.
Strengthening Accountability Across Health Care & Human Services Programs
Public health and human services programs, including Medicaid, Medicare, child care, food and nutrition services, and other public benefit programs, operate in a complex and evolving environment. Ensuring that payments are accurate, services are appropriate, and public funds are used as intended requires coordinated, data-driven program integrity strategies.
Program integrity spans the full lifecycle of these programs, from eligibility and enrollment to service delivery, payment, oversight, and reporting. As delivery systems evolve and regulatory expectations expand, agencies must align oversight activities across multiple programs, providers, and funding streams.
We support federal, state, and local agencies in strengthening program integrity functions across public health and human services programs. We perform our work on behalf of government agencies, providing independent, objective, and data-driven insight to support accountability and effective program administration.
Where We Support Program Integrity
Ensuring that payments are accurate and services are appropriate is central to program integrity efforts.
We provide medical review, payment validation, and audit support across Medicare, Medicaid, and human services programs, helping agencies identify improper payments, strengthen oversight, and align with federal audit requirements.
Managed care and third-party delivery models introduce unique oversight challenges across health care and human services programs.
We support agencies in monitoring managed care organizations and vendors, including pharmacy benefit managers (PBMs), third party administrators (TPAs), and other contractors, ensuring compliance with contractual and regulatory requirements and strengthening accountability across delegated functions.
Accurate eligibility determinations are foundational to program integrity across health care and human services programs.
We support agencies in evaluating eligibility processes, identifying risk areas, and strengthening controls to improve accuracy, compliance, and program accountability.
Identifying and addressing fraud, waste, and abuse is a core component of program integrity.
We support agencies through data-driven analysis, targeted reviews, and investigative support, thus helping identify aberrant billing, utilization patterns, and potential overpayments across providers, vendors, and programs.
Data analytics is central to effective program integrity.
We use advanced analytical tools and methodologies to identify risk areas, support audit selection, and provide insight into utilization, billing patterns, and program performance across health care and human services programs, including Medicare fee-for-service and Medicare Advantage environments.
Sustainable program integrity requires strong operational infrastructure and effective systems.
We support agencies in designing workflows, implementing program integrity systems, including surveillance and utilization review subsystem (SURS), and improving reporting and case management processes, all of which helps strengthen day-to-day oversight functions and long-term program effectiveness.
Estate recovery programs support appropriate recovery of Medicaid expenditures in accordance with federal requirements.
We assist agencies in administering and strengthening estate recovery programs through data analysis, case identification, and process improvement.
Grant-funded programs require strong oversight to ensure funds are used appropriately and program requirements are met.
We support agencies in monitoring grant compliance, evaluating program performance, and strengthening financial and operational controls across public health and human services programs.
Human services programs require the same level of oversight, compliance, and accountability as public health programs, often within complex federal and state frameworks.
We support agencies in strengthening program integrity across areas such as child care subsidies, food and nutrition programs, and other state-administered benefits, ensuring accurate payments, compliant service delivery, and effective program administration.
Supporting Accountability Across Public Programs
We help agencies strengthen program integrity functions, improve payment accuracy, and ensure responsible stewardship of public funds. Our focus is on delivering practical, data-driven solutions that enhance transparency, accountability, and long-term program sustainability across health care and human services programs.
Why Agencies Hire Myers & Stauffer
Program integrity activities are interconnected across eligibility, service delivery, payment, and reporting functions. Risks often span program boundaries, particularly in environments that include managed care, third-party vendors, and multiple funding streams.
Our integrated approach helps agencies:
Our program integrity services are grounded in decades of experience supporting public health and human services programs. We bring:
We understand how program integrity functions operate within state agencies and federal oversight frameworks, and we tailor our approach to align with each agency’s structure, priorities, and regulatory environment.
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.
Ryan Farrell, CFE
Principal
Email: rfarrell@mslc.com
Phone Number: 512-342-0800
Emily Wale, CPA, CFE
Member
Email: ewale@mslc.com
Phone Number: 317-815-5466
Jenna Hall, CPA, CFE
Member
Email: jhall@mslc.com
Phone Number: 919-829-7430
Missy Parks, CFE, AHFI
Principal
Email: mparks@mslc.com
Phone Number: 410-581-4548
In the Words of our Clients…
Recent Insights
We’re committed to advancing government health care through thought leadership, collaboration, and the open exchange of ideas that drive better outcomes. Explore our latest blogs, client alerts, case studies, and thought leadership to see how our expertise can support your goals.
