Program Integrity2021-08-02T19:37:43+00:00

Program Integrity


We ensure that government funds are spent according to program rules and regulations.  We identify and monitor existing issues, provide early warning for potential problems, and recommend and implement viable short- and long-term solutions.

OUR SERVICES

Operational Reviews

Field Studies

Data Analysis

Program Reviews

Desk and Documentation Reviews

Contractor Oversight

OUR STRATEGY FOR SUCCESS

HIGHLY
QUALIFIED STAFF

Quality Assurance Analysts

Former OIG Investigator

Subject Matter Experts

THE RIGHT TOOLS & TECHNOLOGY

Microsoft Dynamics

Secure document sharing platforms (such as SharePoint)

PROVEN
PROCESSES

Use of protocols and checklists for all reviews

Use of “boots on the ground” approach when appropriate

CMMI Level 3 processes

OUR SUCCESS STORIES

Helping Define the CMS Program Integrity Process

THE ISSUE

When CMS was transitioning from using Zone PI Contractors (ZPICs) to Unified PI Contractors (UPICs) to carry out program integrity efforts across the Medicare-Medicaid continuum, it needed to know what ZPIC processes were most successful so it could apply them to its upcoming UPIC procurement process.

THE RESULT

As the Program Integrity Operational Review Contractor (PI ORC), NHA conducted site visits at three different ZPICs, consisting of employee interviews, process evaluations, data analysis and document reviews. At the conclusion of the visits, NHA produced a comprehensive set of seven universal recommendations, allowing CMS to implement the best ZPIC practices across all ZPICs and in the UPIC statement of work.

Helping Define the CMS Program Integrity Process

THE ISSUE

When CMS was transitioning from using Zone PI Contractors (ZPICs) to Unified PI Contractors (UPICs) to carry out program integrity efforts across the Medicare-Medicaid continuum, it needed to know what ZPIC processes were most successful so it could apply them to its upcoming UPIC procurement process.

THE RESULT

As the Program Integrity Operational Review Contractor (PI ORC), NHA conducted site visits at three different ZPICs, consisting of employee interviews, process evaluations, data analysis and document reviews. At the conclusion of the visits, NHA produced a comprehensive set of seven universal recommendations, allowing CMS to implement the best ZPIC practices across all ZPICs and in the UPIC statement of work.