With the shifting executive and regulatory priorities impacting the U.S. healthcare system, advances in technology, and the ever-growing scope and complexity of access, care, and payment models, federal healthcare agencies must change the way they oversee and operate their healthcare programs.
For the path forward, KPMG’s Program Integrity offering can help agencies determine clear strategies for accomplishing mission objectives that go beyond chasing fraud, waste, and abuse. It can be used to continually monitor mission results and risks as well address potential problems. When applied holistically, our Program Integrity offering enables the use of technology, including data and analytics and intelligent automation, to drive transformation of current processes and create opportunities to eliminate repetitive manual tasks; allowing employees to focus on strategic initiatives. Just as critical, it can breakdown internal barriers, emphasizing the importance of collaboration, teamwork and lasting partnerships with key stakeholders across public and private sectors.
How KPMG can help
At KPMG, we understand the intricacies of delivering innovative technical services within the multifaceted federal healthcare, regulatory, and business environment. KPMG’s Program Integrity service offering is risk-based and agile, with technology infused in every aspect, to deliver the strategic and operational capabilities federal agencies need. We help our clients obtain deep insights in planning how to move forward so they can achieve outcomes that are focused on the effectiveness, efficiency, accountability, and transparency of a program achieving its goals.
Our insights
Payment Integrity Information Act of 2019
A new law to improve efforts to identify and reduce government-wide improper payments presents several changes to prior legislation, including the addition of more risk indicators and contributing risk factors, enhanced reporting requirements, and mandatory recovery audits.
Leading the way in program integrity
The U.S. healthcare system is undergoing rapid changes and growing steadily. Spending on healthcare has reached $3.3 trillion, comprising nearly 18 percent of the U.S. economy.
Challenges and opportunities of program integrity for Federal Healthcare
Federal healthcare spending is expected to rise to almost $1.5 trillion for fiscal year 2023. In turn, federal leaders are under enormous pressure to endure the complex array of healthcare programs meet mission objectives and public expectations.
Driving Healthcare results through strong program integrity
Healthcare programs consumed 27 percent of Federal spending this year...
Switching gears: Expanding program integrity beyond fraud, waste, and abuse
This white paper elaborates on the broad meaning of program integrity in the context of federal healthcare.
Program Integrity equals Public Trust
This article, reproduced with the permission of the Association of Government Accountants, discusses how federal agencies can restore public trust in government by implementing a five-dimension program integrity framework that fosters strong program performance.
Maximizing Mission Integrity
A candid survey of program officers at federal healthcare organizations
Federal healthcare agencies provide a new perspective on the challenges of achieving program integrity
Programs suffering from waste, fraud, abuse and increasing improper payments are low-hanging fruit when it comes to cutting federal spending, since they require little-to-no political will to address; government efficiency is a nonpartisan issue.
Viewing ERM in the context of program integrity
This article, reproduced with the permission of the Association for Federal Enterprise Risk Management (AFERM), discusses how establishing and maintaining program integrity entails strong enterprise risk management.
