History

Health Integrity (HI), LLC, is a wholly owned subsidiary of Quality Health Strategies (QHS), Inc.  QHS was created in 2007.

Health Integrity, LLC
Health Integrity (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 November 14, 2009, as a result of a restructuring of the program by CMS, Health Integrity, LLC became the National Benefit Integrity (BI) MEDIC. Compliance and enforcement issues are now handled by another Medicare contractor.  As the National BI MEDIC, Health Integrity has responsibility for fraud, waste, and abuse issues in all parts of the United States.

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.

On September 3, 2009, CMS awarded Health Integrity the Audit MIC (Medicaid Integrity Contract) Task Order 5 which performs fraud, waste, and abuse audits for Medicaid providers for 10 states in the Midwest:  MN, WI, MI, NE, IA, IL, IN, OH, KS, and MO.

On September 17, 2009, HI was awarded another Audit MIC (Medicaid Integrity Contract) Task Order. This is Audit MIC 1R the Southeast region of the U.S. from Pennsylvania to Florida. In combination with our MIC 5 award we will have 23 states and the District of Columbia to perform fraud, waste and abuse audits of Medicaid providers. Four types of audits will be performed - comprehensive and focused onsite audits,desk audits and cost report audits.

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