The Western Integrity Center (WIC) has been a Medicare Program Safeguard (PSC) Contractor since July 2000. As a PSC, the WIC is responsible for the detection and prevention of Medicare fraud and abuse in several states. The jurisdiction covered by the WIC includes Alaska (Part A & B), Arizona (Part A & B), Colorado (Part B), Hawaii (Part B), Idaho (Part A & B), Iowa (Part B), Minnesota (Part A), Montana (Part A & B), Nevada (Part B), North Dakota (Part A & B), Oregon (Part A & B), South Dakota (Part A & B), Utah (Part A & B), Washington (Part A & B), Wyoming (Part A), and three U.S. Pacific territories. Specifically, the WIC performs the following functions for CMS as a PSC:
In September 2004, CMS expanded the WIC’s scope of work in the state of Washington by establishing a Medicare-Medicaid (Medi-Medi) program with the Washington Department of Social and Health Services (DSHS). The CMS Medi-Medi match program is intended to identify suspected overpayments and fraudulent billings where claims data from both programs are analyzed together to detect patterns that may not be evident when billings for either program are viewed in isolation. In June 2006, the WIC was awarded a task to perform data analysis and medical review to identify and investigate any potential fraud, waste, abuse, and program vulnerabilities that may exist in the Competitive Acquisition Program (CAP). The CAP provides an opportunity for Medicare physicians to continue to buy and bill drugs and biologicals or to have them furnished to them by competitively selected contractors upon submission of a prescription for a particular eligible Medicare beneficiary. Under the latter, providers would bill for the administration of the drug only. The WIC staff is strategically located throughout a wide geographic area. Program management staff are located in Baltimore, MD (just minutes from CMS). Skilled, experienced fraud investigators are located in Everett, WA, Peoria, AZ, and Denver, CO, providing coverage of the WIC territory and coordination with three Office of the Inspector General Regions, as well as various other law enforcement entities; with medical review, complaints, and data analysis functions performed in Easton, Maryland. |
| Client Centers for Medicare & Medicaid Services (CMS) |
| Location Baltimore, Maryland |
| Program Manager Jeffrey D. Richards richardj@admedcorp.com |