CMS Selects Qlarant as a Unified Program Integrity Contractor to Detect, Prevent, and Deter Fraud, Waste, and Abuse in Medicare and Medicaid in 20 States
Easton, Maryland—March 7, 2018 —The Centers for Medicare & Medicaid Services (CMS) has selected Qlarant (formerly Health Integrity, LLC) as a Unified Program Integrity Contractor (UPIC) to detect, prevent, and proactively deter fraud, waste, and abuse in Medicare and Medicaid Programs. This designation will allow Qlarant to perform functions to reduce fraud, waste, and abuse (FWA) in the Western and the Southwestern geographic area or “jurisdiction.”
“We are extremely excited to have this opportunity,” said Sandy Love, President of Qlarant Integrity Solutions. “We have a dedicated team of professionals comprised of investigators, nurses, auditors, and data analysts who bring extensive experience and subject matter expertise to the work at hand. We are ready and prepared to do this important work.”
Under CMS direction, Qlarant will perform various functions to detect, prevent, and deter specific risks to the integrity of the Medicare and Medicaid programs. These vulnerabilities may be a result of billing approaches, program changes, or innovations (e.g., use of electronic medical records). The UPICs are required to perform their work in compliance with all federal and state laws and regulations, CMS requirements, and Medicare and Medicaid manuals.
Qlarant, headquartered in Easton, Maryland, has been a national leader in battling FWA and has offices and home-based associates across the country. “We look forward to first task the opportunity to continue working to ensure Medicare and Medicaid funds are properly protected,” continued Love.
CMS’ goals are to achieve enhanced FWA detection and prevention across the Medicare and Medicaid programs, ultimately saving millions of dollars annually. The Western jurisdiction includes the states of Washington, Oregon, Idaho, Montana, Wyoming, California, Nevada, Utah, Arizona, North Dakota, South Dakota, Alaska and Hawaii. The Southwestern jurisdiction includes 7 states: Colorado, New Mexico, Texas, Oklahoma, Louisiana, Arkansas, and Mississippi.
Qlarant uses a combination of advanced technology, data analytics, and expert evaluation to provide a powerful process consistent with CMS’s goals and expectations, which will ultimately benefit Medicare beneficiaries and Medicaid recipients.
Qlarant is a not-for-profit nationally respected leader in fighting fraud, waste & abuse, improving program quality, and optimizing performance. The company uses subject matter experts and innovative data sciences and technology to help organizations see risks, solve problems, and seize opportunities. Solutions are customized for health and human services organizations, government agencies, and financial and insurance companies. The Qlarant Foundation is the mission arm of the organization and provides grants to services provided in underserved communities. Qlarant employs nearly 500 people and has a 45-year record of accomplishment improving the performance of some of the Nation’s most important programs. www.qlarant.com
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