PCG has been performing program integrity consulting services for state government agencies for more than 25 years. Our work includes compliance reviews and program audits for state health agencies across the U.S.
In North Carolina, 213 problematic providers have closed down or stopped billing the state’s Division of Medical Assistance upon being audited by PCG. As the client agency noted, “It’s impossible to put a price tag on the deterrent effect of our efforts. We may never know just how many millions we will prevent from ever going out the door. This is the real value of the Department’s fraud prevention programs.”
Through the audit process, PCG identifies millions of dollars in potential overpayments to non-compliant providers.
Audits put the provider community on notice for increased scrutiny of their billing practices. As a result, provider billing rates decline. In addition, audits force delinquent providers to produce missing paperwork to substantiate their billing claims, increasing accuracy and transparency in the claiming system.
In addition to confirming that providers are billing a client organization in compliance with that agencies regulation, a review ensures that providers have the appropriate underlying financial records to support their claims. Beginning in 2010, PCG has been conducting annual claims reviews of hospitals and community health centers for the Commonwealth of Massachusetts Division of Health Care Finance and Policy, Health Safety Net. The average amount of funds recouped by the Commonwealth as a result of PCG reviews is $500,000 annually.
For more information about PCG Health's Cost Allocation Services please contact us at
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