Our Services
Data Analysis
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We use sophisticated data analysis and the latest statistical methods to identify program vulnerabilities, potential overpayments, and potential fraud and abuse. Our innovative analyses convert large databases into useful information for decision-makers, while ensuring quality and data integrity.
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Descriptive and exploratory statistics
Association studies
Outlier analysis
Time-trend analysis
Regression analysis
Cluster analysis
Volatility Indexing
We use a multidisciplinary approach with a team of data analysts, statisticians, database administrators, regulatory analysts, and subject matter experts. We also formulate hypotheses based on programmatic knowledge, experience, and review of regulations.
Our high level of facility security protects sensitive data and we use state-of-the-art statistical methods and sophisticated software like SAS, Business Objects, and SQL.
Our analyses include: -
Regulatory Analysis
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Our regulatory analysts are experts in a variety of federal regulations and policies including: Medicare, Medicaid, HIPAA, Anti-Kickback Statute, Stark Law and corporate compliance.
We work with federal agencies to evaluate management structure and operating procedures, develop compliance oversight strategies and conduct risk assessments and risk remediation.
We research complex Medicare and Medicaid regulations and policies, and help clients apply these rules to coverage and eligibility, services, and payment systems.
We maintain up-to-date awareness of new initiatives and proposed rules and develop and revise policies and procedures.
We develop education and training materials to assist with agency compliance program implementation and other high risk areas.
We work in conjunction with our Data Analysts, Statisticians, and Subject Matter Experts in the investigation and data analysis of fraud, waste, and abuse activities, by providing regulatory background and support to these analyses.
Claims Processing Compliance Guidance
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Our team has in-depth knowledge of how health insurance claims should be processed to comply with government regulations. This knowledge has been accumulated through extensive experience analyzing claims processing for Medicare, Medicaid, and commercial payers.
We understand claims processing requirements for all provider types and events – inpatient hospital, outpatient, physician and specialty providers, durable medical equipment, and prescription drugs.
We have expertise on diagnosis and procedure codes, modifiers, upcoding and “gaming.”
We can identify where claims processing procedures should be improved, and when provider education is needed.
Compliance Reviews
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We lead the field in assessing contractor compliance with government rules and regulations.
We tailor assessments to the specific elements of the government program and/or contract being reviewed.
We design, develop, implement, monitor and evaluate compliance assessment programs
We identify compliance program gaps and risks.
We provide technical assistance in developing compliance issues for referral to law enforcement.
We follow generally accepted standards for planning, data collection (including interviews), documentation, analysis, and reporting.
We can identify compliance gaps and make actionable recommendations.
Our reviews cover both federal and state requirements.
Fraud Investigations
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Our team of seasoned investigators has senior-level experience in the FBI, Treasury Department, and Offices of Inspector General in several federal departments. We have managed Medicaid Fraud Control Units and Medicare fraud enforcement initiatives.
We conduct confidential investigations of allegations ranging from misconduct to fraud.
Our professional investigators combine sophisticated data analysis with key informant interviews and review of legal and regulatory requirements.
Our investigative products are suitable for administrative or criminal follow-up action.
Audit Services
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We have decades of audit experience in government and the private sector.
We have conducted audits for the Center for Medicare & Medicaid Services (CMS), the Department of Homeland Security, CMS Medicare Program Integrity Contractors, and the private sector. -
Program performance audits
Assessment of existing audit plans and procedures
Design, development and implementation of audit programs and protocols
Credentialing audits
Claims audits
Regulatory compliance and enforcement audits
We follow the Generally Accepted Government Auditing (Yellow Book) Standards.
Our audit services include:
Program Evaluations
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We are expert in designing and conducting evaluations. Several of our senior staff led and managed evaluations in federal Offices of Inspector General.
We use a mix of qualitative and quantitative methods and conduct short turnaround as well as longitudinal evaluations -
Efficiency and/or Effectiveness reviews
Client satisfaction reviews
Development and assessment of performance measures
Development of evaluation protocols
Training of evaluation staff
We follow the Quality Standards for Inspections (Blue Book) adopted by the President’s Council on Integrity and Efficiency.
Our evaluation services include:
Training Programs
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We have been developing and delivering customized training programs for 15 years. We offer on-site classroom training, train-the-trainer, curriculum development, and E-learning solutions.
Training covers a range of subjects, such as risk management, auditing, conducting investigations, effective writing, and program evaluation methods.
Courses are customized for each client.
Courses are practical and directly related to participant’s duties.
Dynamic, knowledgeable instructors use proven techniques to foster interest and active participation.
Strategic Planning
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Our senior consultants use their extensive prior experience leading key Federal agencies to help government agencies develop and monitor their strategic plans.
We assist agencies in creating their mission statement as preparation for the formulation of a strategic plan.
We conduct a gap analysis to determine the missing elements needed to achieve their mission.
We help establish organizational goals and objectives.
We develop performance measures to gauge progress toward meeting the goals and objectives of the strategic plan.
We train managers and staff on the strategic plan and the use of performance measures.
We assist in independently assessing the progress of the strategic plan.