Spotlights > Medicaid Fraud, Waste and Abuse
Medicaid Fraud, Waste and Abuse Remediation Services
To uncover fraud or abuse, counties throughout New York State are turning to The Bonadio Group (TBG) to perform operational, policy compliance, billing and medical necessity audits of selected laboratories, pharmacies, transportation companies and physicians receiving reimbursement from their Medicaid programs. TBG has a well-qualified team of auditors, medical review staff, and investigators who have experience with Medicaid, compliance and claims auditing.
We are well equipped to audit a provider’s compliance with applicable Medicaid regulations and policies, acceptable billing practices, and principles of medical necessity. TBG is prepared to work with counties across New York State on the VERIFY New York program, as well as with other New York State Department of Health initiatives.
TBG has performed numerous Medicaid regulatory documentation audits for compliance, provider claims audits, and Medicaid program contract audits. We bring many years of utilization review and claims adjudication experience with us from the viewpoint of the insurance industry, specifically, disability, health maintenance organizations, and the independent physician association. We have previously partnered with insurance carriers and attorneys to conduct comprehensive utilization reviews of provider claiming patterns.
Our expertise with these services has earned us a reputation within New York State for our results and the quality and comprehensiveness of our work.
TBG has established ourselves at the forefront of Medicaid compliance along a continuum from planning service provision through Medicaid claim submission; to service provision through the application of external regulatory compliance auditing and monitoring.
For more information on Medicaid Fraud, Waste and Abuse services, call us at (800) 487-7624 or contact us.
