The Medicare Integrity Program (MIP) and Payment Safeguards was initiated in the spring of 1999 by the Centers for Medicare & Medicaid Services "CMS". Thirteen Program Safeguard Contractors (PSCs) were awarded Indefinite Quantity (IDIQ) contracts to perform program integrity and data analysis. This system of payment safeguards identifies suspicious claims throughout Medicare, and insures that Medicare does not pay claims other insurers should pay.

Under the Program Safeguard Contract (PSC), AdvanceMed Corporation provides investigative services to detect and prevent fraud and abuse in the Medicare systems in 23 states across the nation.

Our team of over 200 professionals, located in offices in 13 states, performs a wide range of forensic functions in an effort to assure that taxpayer dollars are protected and that the Medicare and Medicaid programs maintain the highest degree of integrity.

These functions include:

• Reviewing and assessing beneficiary complaints to identify potential fraud
• Investigating fraud cases to obtain evidence for potential legal or administrative actions
• Performing expert medical reviews to determine whether the medical records show evidence of fraud
• Conducting sophisticated data analysis to detect potential fraud cases from both the pre and post payment perspective using:
  • Rule violations
  • Statistical outliers
  • Cross claim incompatibilities through link analysis
  • Ad hoc queries and drill-down analysis
  • Advanced predictive modeling techniques
  • Statistically valid sampling approaches
• Delivering provider education to ensure that the provider community has a good understanding of the regulations, pertinent policy and implication of fraud
• Identifying and establishing pre-payment controls to identify potential fraud before processing claims payments
• Working closely with federal law enforcement officials to provide evidence, expert testimony, and relevant policy to build strong fraud cases

Program Safeguard Contract Territories