Insight. Clarity. Solutions.

Our focus: To provide high quality services to increase efficiency and effectiveness and improve compliance with regulations.

Integrity Management Services, LLC (IMS), is a Veteran-Owned Small Business, founded by the former Inspector General of Health and Human Services, Richard Kusserow. IMS’ mission is to provide high quality services to increase efficiency and effectiveness of our clients’ programs, and improve compliance with government regulations.

Focused on strengthening the performance, integrity, and overall effectiveness of government programs, we are experienced and skilled in the establishment, maintenance, auditing, and quality improvement government organizations which includes fraud, waste, and abuse as well as compliance and enforcement initiatives.

ExperienceIMS is a seasoned team of professionals, including former government program managers and subject matter experts (SMEs) in various government programs. Our highly-qualified technical and educated team consists of: • auditors • data analysts • evaluators • investigators • regulatory analysts • SMEs • statisticiansWe specialize in complex data and statistical analysis,

auditing, program evaluation, and investigations. Our data analysts, subject matter experts, and statisticians convert theory into workable, informative analysis. We have a highly effective staff with experience and skill in creating large databases, building support systems for our auditors, evaluators, and investigators and establishing secure communications networks with our clients. Our audit team has in depth experience in the design and conduct of complex audits and compliance reviews. We have written and established quality assurance procedures in place to ensure we produce quality products for our customers.

DepthOur multi-disciplinary team supports our clients’ needs in audits, compliance reviews, data mining and analyses, investigations, program evaluation, regulatory analysis, and training. We are skilled and proven at problem solving and vigorous in seeking innovative ways to approach our tasks. Continuous quality improvement is an IMS core value.

Our experience includes

but is not limited to

supporting:

• US Department of Health and

Human Services

 Centers for Medicare

& Medicaid Services

 Health Resources and

Services Administration

 Office of Civil Rights

 Office of Medicare

Hearings and Appeals

 Office of the Inspector

General

• Office of Personnel Management

• U.S. Postal Service

• Veterans Affairs

• United States Air Force

• TRICARE

• Various States

Capabilities

AuditsWe have decades of audit experience in government and the private sector. We follow the Government Auditing Standards (Yellow Book). Our staff have served in managing capacities at various Federal Inspector General offices.• Our audit services include:

 Claims audits  Regulatory compliance audits  Program performance audits  Assessment of existing audit plans and procedures

Compliance ReviewsWe are proficient in assessing contractor compliance with government rules and regulations. We identify compliance gaps and make actionable recommendations.• We tailor assessments to the specific

elements of the government program and/or contract being reviewed.

• We follow generally accepted standards for planning, data collection (including interviews), documentation, analysis, and reporting.

• We identify compliance gaps and make actionable recommendations.

• We implement corrective actions• Our reviews cover both Federal and

State requirements.

Data Analysis We use sophisticated data analysis and statistical methods to identify program vulnerabilities, potential overpayment, and potential fraud, waste, and abuse. Our innovative analyses convert large databases into useful information for decision-makers, while ensuring quality and data integrity. Our Federal Information Security Management Act (FISMA) compliant facility protects sensitive data.

• We use a multidisciplinary approach with a team of data analysts and SMEs.

• We formulate hypotheses based on programmatic knowledge, experience, and regulatory review.

• Our high level of facility security protects sensitive data.

• We use state-of-the-art statistical methods and sophisticated software like SAS and SQL.

• We use stringent quality assurance methods to deliver high quality products.

• Our analyses include: Â Descriptive and exploratory statistics

 Predictive analytics  Time-trend analysis  Association studies  Regression analysis

EvaluationsWe are expert in designing and conducting program and project evaluations. Several of our senior staff led and managed evaluations in federal Offices of Inspector General. We follow the Quality Standards for Inspection and Evaluation (Blue Book).• We use a mix of qualitative and

quantitative methods.• We conduct short turnaround as well as

longitudinal evaluations.• We follow the Quality Standards for

Inspection and Evaluation (Blue Book) issued by the Council of the Inspectors General on Integrity and Efficiency.

• Our evaluation services include: Â Efficiency and/or Effectiveness reviews

 Client satisfaction reviews  Development and assessment of performance measures

 Development of evaluation protocols

 Training of evaluation staff

InvestigationsOur team of seasoned investigators has senior-level experience in the Federal Bureau of Investigation, Treasury Department, and Offices of Inspector General in several Federal departments. The team has staff that is experienced at managing Medicare fraud enforcement initiatives and Medicaid Fraud Control Units. • We conduct confidential investigations

of allegations ranging from misconduct to fraud.

• Our professional investigators combine sophisticated data analysis with key informant interviews and review of legal and regulatory requirements.

• Our investigative products are suitable for administrative or criminal follow-up action.

Medical ReviewsOur medical review team is capable of conducting Medicare, Medicaid, fee-for-service and managed care reviews of health care services and pharmacy across a wide-variety of service areas and clinical topics. The team includes:• Pool of subject matter experts covering

a wide variety of medical specialties, care management, behavioral health, and pharmacy.

• Pool of experienced medical directors, medical review nurses, certified coders, and fraud analysts to conduct claims reviews and determine medical necessity or potential fraud.

Business Information

NAICS Codes

561611 - Investigation Services

541611 - Administrative Management & General Management Consulting Services

541990 - All Other Professional, Scientific, & Technical Services

518210 - Data Processing, Hosting, & Related Services

541618 - Other Management Consulting Services

541720 - Research & Development in the Social Sciences & Humanities

DUNS02-1680784

CAGE Code5WS42

GSA Schedule – FABSGS-23F-0047XGS-23F-0048X

MOBISGS-10F-0479R

SWaM Certification699335

For Information Phone: Email: Web: Address:703.683.9600 info@integritym.com www.integritym.com 5911 Kingstowne Village Pkwy

Suite 210, Alexandria, VA©2013 Integrity Management Services LLC. All rights reserved.

Integrity Management Services (IMS) worked on an innovative contract with the Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) called the Comparative Billing Reports (CBRs).

CBRs are nationally distributed Medicare provider education tools that statistically compare unique providers to their specialty, region, state, and/or national peers. The goal of the CBR is to inform and educate the providers receiving the report of proper billing practices, how they rank compared to their peers, and encourages the providers to conduct a self-audit of their practice. Each CBR supports the CMS initiative to protect the Medicare Trust Fund from improper payments.

IMS was the lead producer of the nationally distributed CBR between 2009 and 2013, producing nearly 150,000 unique reports. Medicare vulnerabilities such as physical therapy, chiropractic, imaging, ambulance, and podiatry services as well as home health, hospice, and skilled nursing facility billing are examples of individually reported CBR topics.

In an effort to gauge the efficacy of CBRs on the Medicare provider community, several vulnerability report topics were repeated using updated data in 2011. To utilize a CBR on physical therapy billing as an example, the statistical analysis evaluating

the effect of the CBR confirmed the CBR had a significant impact on the overall billing of the Medicare providers who received the initial report. An analysis of follow-up comparative billing reports proved that over $120 million dollars worth of services had decreased from the first CBR report to the second, which is a direct and significant cost savings to CMS.

In two other CBR topic analyses where the number of services billed to CMS were studied, similar trends of reduction were shown to occur, with an average of a 13% reduction.

Case in Point

Physical Therapy Vulnerability Topic comparison2009 - 2011