Program Integrity

Regulatory and technological advances, combined with the complexity of care delivery, access, and alternative payment models, are forcing health care oversight and operations to evolve.

We create risk-based compliance and audit solutions while cultivating actionable strategies and data-driven insights to reduce the impact of fraud, waste, abuse, and improper payments alongside achieving program goals, which always includes preserving program integrity.

By focusing on stewardship and trust, we build partnerships across the public and private sectors to continually monitor performance, drive transformation, and vigilantly address risks.

Bland’s cross-functional teams of subject matter experts offer diverse experience identifying risks and vulnerabilities in existing programs and new payment and delivery models. Our deep knowledge of government programs at the federal, state, and local levels enable us to identify and use a wide variety of data sources, best practices, and approaches. We use technology to analyze multiple data sources to determine if certain activities and behaviors could lead to potential noncompliance and warrant further investigation. Sound sampling approaches are based on mining, refining, and extracting the right data and can be upheld in the case of disputes.

Some examples of our firsthand experience include vetting providers for sanctions, eligibility to bill Medicare, medical records review, coding manipulation, duplicate billing, price transparency in prescription drug data, and payment and reporting accuracy. We focus on understanding the data, intent, and protocols of a health care system to spot inconsistencies and potential fraud, waste, abuse, and improper payments, which makes us a valuable partner for our clients.

 

Your Lifeline for

Real Results.

“Over the last three years, Bland worked to meet the needs of our alternative payment model. The contractor provided deliverables in a timely manner. They innovated by coming up with unique strategies for screening practices to determine their risk level for our alternative payment model. Their extensive budget analyses for assessing practices’ use of CMS funds provided useful data for the auditing work stream and the model as a whole. Each year Bland’s strategic approach along with its subcontractor…came in under budget and exceeded our standards.”
– CMS Contracting Officer
“[The Bland team has] been very easy to work with…audits can vary a lot based on who the auditor is. Some making it more difficult than others. We have enjoyed working with your team and this has made the audit work go smoothly.”
– Vice President at Blue Cross Blue Shield
“I will truly miss working with all Bland auditors over the years. Many thanks to all. Every one of you have been incredibly professional, detailed, and pleasant to work with.”
– Pharmacy Benefit Manager Senior Audit Advisor
“CMMI was very complimentary to the…Bland compliance team. They appreciate the team’s high-quality work and flexibility and mentioned that the team is “exceptional” and great to work with.”
– Government Contractor Vice President
“It really was team effort. CMS could not have accomplished this without.. Bland’s hard work. And speaking for myself, it is amazing to see where we are now compared to where we were a year ago. I hope you all take pride in that change, because it was the hard work of all of you that got us here.”
– CMMI Model Team Lead
“This level of independence and thoughtful evaluation/assessment of what works best for moving the work forward is greatly appreciated by CMS.”
– CMS Director
“The Bland team has been very responsive to CMS urgent asks. They put together concise and structured background documents quickly and with very little direction.”
– CMS Contracting Office Representative
“…..Bland provided excellent, responsive customer service. We received no complaints from the over 150 practices that the contractor interacted with during the auditing process.”
– CMS Contracting Officer
“Thanks a lot, again my apologies for the last-minute request but I know that I can always count on Bland team.”
– CMS Monitoring Lead
“Over the last three years, Bland worked to meet the needs of our alternative payment model. The contractor provided deliverables in a timely manner. They innovated by coming up with unique strategies for screening practices to determine their risk level for our alternative payment model. Their extensive budget analyses for assessing practices’ use of CMS funds provided useful data for the auditing work stream and the model as a whole. Each year Bland’s strategic approach along with its subcontractor…came in under budget and exceeded our standards.”
– CMS Contracting Officer
“Payment and performance validation through compliance oversight and audits of model participants is a critical step in evaluating effectiveness of the … CMMI innovative payment and service delivery models. Bland has done a fabulous job in planning and executing a robust auditing support and program integrity services to help: – Greatly reduce participant burden – Align with the CMS goal to keep participant focus on patient care – Reduce the necessity of remedial actions – Improve compliance monitoring audit outcomes leading to model success – Enhance model participants’ overall compliance experience.”
– CMS Contracting Officer
“Thank you so much. You are simply the best and most responsive partner.”
– Accountable Care Organization Regional Coordinator
“Bland is constantly looking (to) enhance…monitoring…at the same time finding ways to reduce provider burden aby clearly communicating expectations, performing targeted outreach and education, clarifying and removing compliance ambiguities in the Participation Agreement (PA).”
– CMS Contracting Officer
“The contractor’s cost management is exceptional…All of the contractor’s work and products are always within budget and they helped the government develop a COVID-19 strategy that saved the government $1.8M.”
– CMS Contracting Officer
“Bland is the most accommodating contractor that I have ever worked with, moreover, the contractor has always been accommodating and flexible with the needs of the government.”
– CMS Contracting Officer