Compliance
HCE’s experience in the area of health care compliance spans state Medicaid and federal Medicare contracts. Our compliance review experience includes:
- Pattern analysis and trending of claims data to identify high risk areas
- Onsite audits
- Desk audits
- Process analysis and redesign
- Analysis and evaluation of state-conducted compliance reviews
- Corrective Action Plan (CAP) recommendations
- CAP tracking at the health plan level
- CAP technical assistance at the health plan level
Audits
HCE’s approach includes well-defined and proven methods and procedures to identify potentially aberrant provider and recipient practices, to investigate and profile provider practice, to conduct on-site and desk audits, to selectively conduct unannounced audits, and recommend providers for self-audits. We are adept at conducting claim-specific and focused audits as well as utilizing statistically valid random sample provider audits.
We have more than 15 years experience with auditing in physical health and behavioral health settings.
Education
HCE provides educational opportunities to the general public, physicians, and health-care providers in order to establish or increase an understanding of rapidly changing medical issues.
Fraud and Abuse Investigation
HCE has more than 35 years of corporate experience in fraud and abuse, program integrity, and utilization review related to Medicare and Medicaid. We have worked with the Office of the Inspector General in multiple states, including Indiana, Illinois, Iowa, and Kentucky, to provide audit services for potential fraud and abuse cases.
Process Redesign
Part of our mission and vision is a commitment to improving the health status of the communities in which we operate. A focus on the consumer is central to our operations. We work with health care providers and offer evidence-based corrective action recommendations to improve quality of care and patient safety, as well as reduce inappropriate use of services to prevent unnecessary care and costs to the consumer.
For many years, the company has been involved in the review and auditing of workflow processes and procedures for physician offices, hospitals, nursing homes, and home health agencies. Our experience includes workflow analysis, readiness assessments, and assistance with implementing revised procedures for efficiency and effectiveness of operations. We also have experience in external quality review of managed health care plans, assessing their compliance with contracts and assuring their operations are effective and efficient.
