CMS awarded the UPIC West contract to Qlarant in 2017. The UPIC West is a task order contract under the Unified Program Integrity Contractor (UPIC) IDIQ vehicle. Under this contract, Qlarant supports CMS’ audit, oversight and fraud, waste and abuse detection, deterrence and prevention for Medicare and Medicaid claims for the thirteen (13) Western Jurisdiction states (and related territories) of Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming as well as the territories of American Samoa, Northern Marianas Islands and Guam.
The work performed by Qlarant includes: providing Medicare alerts and investigational support to NSC and HHH MACs on enrollment standards; performing comprehensive claim review and data analysis for Part A, Part B and DME and Medicaid claims; conducting independent investigations to identify instances, indicators and patterns of suspected fraud and abuse or patient harm; developing provider and supplier risk assessments and predictive models for CMS and sharing this information with CMS partners; providing Medicare enrollment standards education to providers; and providing subject matter expertise in Medicare and Medicaid laws and regulations.
