History

Health Integrity (HI), LLC, is a wholly owned subsidiary of Quality Health Strategies (QHS), Inc.  QHS was created in 2007 to fulfill the strategic planning goals of Delmarva Foundation for Medical Care (DFMC), Inc., the former parent. 

Delmarva Foundation for Medical Care, Inc., Easton, Maryland
Delmarva Foundation for Medical Care, Inc. (DFMC) is a private, non-profit organization founded in 1973 on principles of quality assurance and improvement for healthcare and social services at affordable costs. DFMC has grown from a small utilization review and quality assurance company in Easton, Maryland to a company of 250 employees with five offices in Maryland, Florida, South Carolina and the District of Columbia dedicated to improving all aspects of quality for people accessing Medicare and Medicaid services. As the federally designated Medicare Quality Improvement Organization (QIO) for Maryland and the District of Columbia, DFMC’s staff of physicians, nurses, other allied health professionals, scientists, social workers, epidemiologists, biostatisticians, analysts, communications and information technology experts oversee the effective operation of federal programs within their jurisdiction. The staff works to ensure program integrity and seeks opportunities to communicate with and educate those who benefit from federal programs.

DFMC is a national leader in External Quality Review of state Medicaid programs, ensuring that those who need services the most, the poor and needy, receive necessary services in a timely and cost-effective manner. DFMC also monitors Florida’s developmentally disabled community who access services through the state’s Home and Community-Based Waiver Program.

Through the Western Integrity Center program, Delmarva’s scientists and analysts work with our partners using state-of-the-art techniques and tools to detect possible incidents of fraud or abuse and report these cases to the appropriate law enforcement agencies. DFMC registered nurses review thousand of claims to assure accurate provider billing, coding, medical necessity, and quality.

HI was awarded Medicare Prescription Drug Integrity Contract (MEDIC) by the Centers for Medicare and Medicaid Services (CMS).  HI is the contractor responsible for performing benefit integrity tasks for CMS related to the Medicare Part D Prescription Drug program.  HI is responsible for monitoring complaints and initiating fraud investigations for referral to the Office of Inspector General (OIG) as well as supporting cases with data, medical and pharmaceutical experience, audits, training and investigative expertise.  This task began on September 30, 2005 and continued until the spring when two additional MEDIC contractors assumed regional responsibility for Part D complaints and investigations.  HI assumed Part D benefit integrity responsibility for the Southeastern United States.  Beginning September 29, 2008 HI took on responsibility for seven additional states and became the South MEDIC covering West Virginia, Virginia, North Carolina, South Carolina, Tennessee, Georgia, Florida, Alabama, Mississippi, Arizona, Louisiana, Oklahoma, Texas, Colorado, and New Mexico as well as Puerto Rico.

On September 30, 2008, HI was awarded the first Zone Program Integrity Contract Health Integrity (ZPIC Zone 4) covering Texas, Colorado, Oklahoma and New Mexico We were awarded the Umbrella Indefinite Quantity Contract and 2 Task Orders under the IDIQ. Task Order 1 is to perform FFS fraud and abuse detection and investigation for Part A, B, DME, Home Health, and Hospice.  Task Order 2 is to perform Medi-Medi fraud and abuse detection and investigation.

Information on the company can be found at www.delmarvafoundation.org.