Solutions and Services

IntegriGuard, LLC is dedicated to safeguarding the integrity and ensuring payment accuracy of federal healthcare programs.

As a leader in the field of detection and deterrence of improper payments, fraud, and waste, our company possesses the staff, skills, and knowledge to help your agency find the solutions you need.

What solutions and services does IntegriGuard offer?

• Fraud Investigation

  Our healthcare fraud team investigates identified leads using a variety of tools and techniques. When an investigation yields evidence indicative of fraud, we develop the case file, work with appropriate law enforcement agencies for acceptance, and continue to provide support through sentencing and conviction.

• Audit

  Our auditors and accountants have audited drug card plans, managed care organizations, and healthcare facilities. We adhere to the 2003 Government Auditing Standards to ensure that each audit plan tests the agreed upon controls, is well supported by documentation, and is reviewed appropriately at each step.

• Medical Review

  Our licensed clinicians assess if services were rendered and/or medically necessary, and if quality of care concerns existed. Each record review articulates findings as well as cites the law, regulation, or coverage policy that supports the determination. A rigorous quality program measures the accuracy and consistency of determinations.

• Enrollment and Eligibility

  IntegriGuard has devised innovative ways to receive, process, and report eligibility, enrollment, and payment accuracy work. We collaborate with key stakeholders to develop a uniform submission process. Our database quickly identifies duplicate and erroneous requests minimizing processing and reporting time.