We show you how to recognize and avoid black holes.
Fraud, Waste, and Abuse
Where are you losing money? There are countless opportunities for fraudulent activities or inaccurate coding in the Medicaid, Medicare, and private insurance systems. We have decades of experience helping state agencies gather and analyze data to uncover vulnerabilities and establish robust oversight.
Constellation Quality Health takes a data-driven approach to health care fraud and waste prevention. We analyze the integrity of data and medical record documentation to get a complete picture of areas of concern. With the support and expertise of our team, you can protect yourself from problematic providers, ensuring that health care dollars are being spent on intended services by quality providers. This, in turn, makes it possible for our partners to provide health care access and services to the beneficiaries who depend on them. We offer:
- Payment integrity
We safeguard your payment system, assuring correct payments and detecting overpayments and invalidities.
- Predictive fraud analytics
We uncover risks and vulnerabilities before they become threats.
- Investigations
Armed with a federal law enforcement background, we expose criminal and civil actions. We offer a fully outsourced Special Investigations Unit (SIU).
- Nonprofit and grant-funding fraud, waste, and abuse prevention
We ensure lock-down adherence to industry laws, rules, regulations, and programs with our expert fraud compliance training and auditing expertise.
- Expert court testimony – hearings and appeals
Our seasoned team has a history in federal law enforcement and a legacy of high win rates for our partners.
If you need help getting a handle on existing issues or simply want to be more proactive in your approach to oversight, contact Constellation Quality Health.