Fraud Waste & Abuse (FWA)
Fraud Waste and Abuse in the healthcare industry exposes patients to potentially harmful services and entities, in addition to increasing the cost of healthcare. It is imperative that we identify and combat FWA to protect the patients and keep the healthcare programs sustainable.
CMS Center for Program Integrity (CPI)
The US federal government agency, Centers for Medicare and Medicaid Services (CMS)' Center for Program Integrity (CPI)'s mission is to detect and combat fraud, waste and abuse of the Medicare and Medicaid programs. CPI's work focuses on protecting patients while also minimizing unnecessary burden on providers
We supported CMS CPI in the modernization of program integrity related systems and data such as provider enrollment, investigative data, medical documentation review and claims and encounters review.
Our modernization effort improved program integrity systems that screen providers during enrollment, remove bad players from the healthcare program and monitor and educate providers on compliance, billing practices and other program requirements
Furthering the Mission
Empowered unified program integrity contractors (UPIC) and Medicare administrative contractors (MAC) with timely access to quality data and enabling collaboration across government agencies to act quickly on investigations and leads
Received positive feedback from CPI stakeholders for enabling access to real-time data via APIs and the improved agility and user experience in our data sharing approaches
Project recognized with a Fed Health IT award