History

On January 27, 2010, Health Integrity received its Certificate of Conformance with the ISO 9001:2008 standards. Scope of its Registration includes product design and development and provision of services related to: quality improvement and fraud detection in health care including fraud hotline, health care data analysis, fraud waste and abuse investigation, medical review, and audits for benefit integrity and pharmacy. The International Organization for Standardization certifies companies that conform to quality standards focusing on continuous quality improvement of processes and customer satisfaction. This Certificate applies to its Easton Corporate Office, the Easton work site, as well as the Dallas and San Antonio offices. This is the second year of Health Integrity’s conformance registration, last year under the 9001:2000 standards. Successful conformance requires a synchronized team effort and commitment by top management who share the goals of exceeding customer expectations by producing high quality and ever-improving products.

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 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.

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.

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