Fraud, Waste, and Abuse (FWA) Audits

Having an effective Medicare FWA prevention, detection, and reporting program in place is required by CMS -- and protects plans financially from potential fraud. GHG’s team of former CMS regulators, health plan managers and pharmacists can conduct a comprehensive audit to determine whether your organization has the necessary measures, processes and procedures in place, and recommend specific steps to take for making sure your FWA program protects your company against predatory actions that pervade the healthcare system.

FWA Audit Components

• Review of the 20 FWA elements, including three sample elements, and compliance determinations of “Met,” “Not Met,” or “Not Applicable” for each element reviewed.
• Comprehensive review of plan policies and procedures to determine compliance with all applicable Medicare regulations and CMS guidance.
• Interviews with key plan personnel in order to perform a complete evaluation of plan processes.
• Preparation and delivery of an executive summary and detailed report containing key findings and recommendations, including common sense approaches for integrating needed FWA operations.

To learn more, please call 202-364-8283 or send us an e-mail at ghg@gormanhealthgroup.com