Yearly Archives: 2018

On August 3, 2018 the DOJ announced coordinated effort to resolve allegations of false claims resulting in a $65 million-dollar settlement for Medicare. Amenity was retained as a subject matter expert and opinion witness for the DOJ regarding allegations involving up-coding, inpatient admissions not medically necessary in the inpatient setting, and falsification of information concerning [...]

Amenity has been engaged for retrospective FWA (Fraud, Waste, and Abuse) services for a State Coordinated Care Organization (CCO). CCOs are networks of providers who agree to work together to serve their local State Health Plan (Medicaid) communities receiving health care coverage. The focus of a CCO is on the management of chronic conditions and [...]

Amenity is engaged to provide PERM audits for a managed Medicaid plan for state reporting requirements. Medicaid participates in CMS Payment Error Rate Measurement annual reviews to identify susceptible, improper, and at risk fee-for-service payments. The estimate of improper payments produces error rates. These error rates are a measurement of payments made that did not [...]