SafeGuard awarded $300M Medicare fraud-prevention contract
- Safeguard Services (SGS), a subsidiary of Hewlett-Packard, has been awarded a $300M contract by the Centers for Medicare and Medicaid Services (CMS) to identify and help prevent Medicare fraud.
- The contract will allow SGS to investigate kickbacks, falsifying claims, billing for services that were not provided, misrepresenting diagnoses and other types of Medicare fraud.
- SGS performs comprehensive problem identification, innovative data analysis, investigation and research to identify potentially-fraudulent Medicare providers, refer resulting cases to law enforcement and pursue administrative actions to prevent fraud and abuse.
Under the contract, SGS will become a zone program integrity contractor (ZPIC). There are seven ZPIC zones in the US, each with their own contractors. With this new contract, SGS will begin overseeing Zone 6 (Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont and Washington, D.C.) in addition to Zones 1 (California, Hawaii, the Mariana Islands and other American territories) and Zone 7 (Florida, Puerto Rico and the Virgin Islands), for which it already had oversite.
ZPIC audits are different from other types of Medicare audits in that they are actively seeking to identify fraud, whereas other audits are conducted in order to determine whether or not payments were disperesed appropriately.
- Modern Healthcare HP subsidiary lands $300M contract to detect Medicare fraud