Special Investigations Unit

# of providers proactively audited

14SFQ4 2022

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Notes on Methodology

The SIU initially set a target of 50 for this measure, but learned that it wasn’t realistic to set a static target number as the number of providers audited quarterly is based on the provider type being audited, and that can vary from quarter to quarter.

Partners
  • Medicaid Providers
  • Gainwell Technologies
  • Provider Member Relations Unit
  • Clinical Operations Unit
Story Behind the Curve

This measure is important because the more providers SIU interacts with the more cost avoidance can be realized. 

SIU seeks to measure the effectiveness of SIU contact with providers to determine if the provider changed their billing patterns going forward after SI involvement.  Data analytics or other leads will identify potential subject area and providers to audit.  SIU strives to audit a variety of providers, educate as appropriate, and recover funds when necessary.

COVID had an impact on this measure as providers were not subjected to proactive audits during that time.

Last updated:  04/04/22

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy