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.
Desk and Documentation Reviews
OUR STRATEGY FOR SUCCESS
Quality Assurance Analysts
Former OIG Investigator
Subject Matter Experts
THE RIGHT TOOLS & TECHNOLOGY
Secure document sharing platforms (such as SharePoint)
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
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.
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.