Integrity Advantage

Integrity Advantage helps healthcare payers and government entities combat fraud, waste, and abuse (FWA) through expert consulting, investigation, medical review, and payment integrity services. Owned and operated by industry professionals, we bring decades of hands-on experience across diverse healthcare plans, offering vendor-neutral guidance and real-world solutions. Our Services: • Program Assessments: Consulting, risk identification/mitigation, FWA compliance. • Operational FWA Support & SIU Outsourcing: Lead generation, investigations, and medical record review. • Training, Education & Mentorship: FWA training and annual mentorship, including medical review mentorship/training and sampling & extrapolation training. Medical Review Team: We conduct initial and appeal-level reviews (with different auditors for appeals), specializing in DRG, professional, and inpatient claims. Our team follows strict privacy standards, providing detailed findings and evidence-based recommendations through thorough documentation, coding audits, quality control, and accurate reporting. Investigations Team: Specializing in overpayment detection, lead generation and validation, peer reviews, and outlier analysis. We use statistically valid sampling, conduct provider/member interviews, offer law enforcement referrals, and support cases through recovery — ensuring compliance and collaboration at every step. Training, Education & Mentorship: FWA training and annual mentorship, including medical review mentorship/training and sampling & extrapolation training. Our Credentials: AHFI, CDEO, CEMC, CEMA, CFE, CHC, CHONC, COSC, COTA/L, CPA-RA, CPC, CPMA, CIC, RN, GStat. Certified as a Women’s Business Enterprise (WBE) and Economically Disadvantaged Woman-Owned Small Business (EDWOSB), we drive innovation and analytics in healthcare fraud prevention. Partner with us to strengthen your FWA program, enhance detection strategies, and drive meaningful results. Let's connect!