Qlarant Integrity solutions is a private company that carries out Medicaid and Medicare investigations and audit on behalf of Centers for Medicare and Medicaid Services (CMS).
The two parties entered into the agreement in 2018. Qlarant was also chosen as one of the (UPICs) – Unified Program Integrity Contractors.
More about Qlarant
While announcing the deal with CMS, Qlarant described itself as “a non-profit organization whose objective is to fight fraud, wastage of money and improve service delivery in the healthcare sector”.
“The company uses data science and experts in different fields to assists companies detect risks, solve problems and take advantage of opportunities” the press release continued to read.
Despite the fact that Qlarant is not a federal agency or institution, it has been given a lot of powers to impose fines and penalties on individuals and companies violating various provisions of various healthcare acts on behalf of the federal government.
Once Qlarant investigating officials prove that a business or company is involved in any form of fraud or malpractice, they are supposed to report the service provider to the Department of Justice (DOJ).
The DOJ will then launch its own independent investigations and charge the company for the offense they have committed.
If a healthcare provider or company is faced with Qlarant audits and investigations, retaining a good and experienced lawyer is important in averting possible severe penalties.
There are many law firms that have extensive experience when it comes to dealing with Qlarant investigations.
The first thing that you should probably do immediately you realize that Qlarant investigators are targeting your business is to inform the law firm. An experienced lawyer understands how Qlarant investigations are done and will advise you appropriately on what to do and what not to do.
Qlarant carries out investigations across different states the country. With the capacity of UPIC, Qlarant has the mandate to carry out Medicaid and Medicare investigations in the following States:
• Alaska Arkansas
• American Samoa
• New Mexico
• Mariana Islands
• North Dakota
• South Dakota
What to expect during a Qlarant audit and investigations
Despite the fact that all CMS contractors are supposed to declare any underpayments and overpayments, Qlarant believes that its main goal is to help recover as much money as possible to the federal government.
It is important to note that Qlarant largely uses sophisticated software to scan and detect any irregularities in the implementation of healthcare programs such as Medicaid and Medicare.
Besides that, they often deploy some of their investigators on the ground if they feel that they can uncover more by conducting interviews to corroborate certain information.
There is no much difference between Qlarant audits and investigation. This is because most of them will always lead to significant penalties and punishment.
The company is also the one to determine if a business will be referred to the Department of Justice (DOJ) or not.
What are the common allegations in Qlarant audits and investigations?
There are two main areas that Qlarant investigators focus on. The first one is a violation of Medicare and Medicaid billing and the second one includes illegal financial dealings between program participating companies.
How the nature of allegations are determined
During Qlarant investigations, the first things always involve unearthing the nature of the accusation against your business.
For instance, is the business being accused of going against Medicaid or Medicare billing regulations? Or is it being accused of using funds meant for Medicaid and Medicare to pay for referrals?
Qlarant investigators will rarely tell you what they are looking for during their investigations. Nonetheless, there are a few ways to know why they are targeting your business. They include the following:
• Analyzing the records requested – The type of records you are being asked to provide can shed light on what the investigations are all about.
• Quick intervention – If you are able to get an experienced lawyer in matters of Medicare and Medicaid to look into Qlrant investigations, then you will be able to understand why they are checking your records.
• Risk assessment and internal audit – Another great way to know what the Qlarant investigation is all about is by carrying out a quick risk assessment and internal audit in your company.
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