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Medicaid Behavioral Health Agency Audit
PCG Company Background
PCG has more than 26 years of experience in behavioral health consulting for state and local governments, reflecting our commitment to quality behavioral health systems.
PCG helps clients todevelop, improve, and refine their system of services for individuals with mental health and substanceabuse challenges and individuals with intellectual and developmental disabilities.In addition to the behavioral health audit services utilized by New Mexico, PCG provides a broad rangeof services designed to strengthen behavioral health delivery systems including: strategic planning,quality management, rate setting, waiver design and management, and Medicaid rebalancing.
PCG and its CEO have been honored by the National Alliance on Mental Illness (NAMI), the Massachusetts Association for Mental Health, and a number of other behavioral health organizations
In the 1990s PCG was a national leader in assisting states to de-institutionalize services for persons with mental illness and establish a comprehensive system of home and community-based care (HCBS). PCG is also a national leader in assisting states to reform programs for studentsreceiving health and mental health services in a school setting.
Overall, PCG is a respected leader in health care management consulting for state governments.
PCG’s mission is to be the market leader in delivering outstanding financial and operational results tohealth, human services, education, and other government clients. PCG is a leading provider of healthcare program integrity and operations improvement services as well as a recognized leader in health carereform and Health Insurance Exchange (HIX) planning and implementation
PCG Audit Capabilities
PCG has demonstrated audit expertise.
Recent examples include:
Oklahoma State Department of Health (OSDH): medical and financial records review of 100 providers that received reimbursement from the state’s Trauma Fund for services provided. PCGidentified 10 percent of reviewed uncompensated trauma care claims submitted by hospitals, physicians, and EMS providers that were not in compliance with the Trauma Fund’s eligibilitycriteria. These claims represented over $1M in Trauma Fund payments.
State of Virginia, Department of Medical Assistance Services (DMAS): statewide community behavioral health services post payment reviews, including on-site and desk reviews, July 2009-March 2012. More than 100 on-site/desk audits were completed, identifying roughly $25 millionin overpayments.