CMS awarded the UPIC Southwest contract to Qlarant in 2017. The UPIC Southwest is a task order contract under the Unified Program Integrity Contractor (UPIC) IDIQ vehicle. Under this contract, Qlarant supports CMS’ audit, oversight and fraud, waste and abuse detection, deterrence and prevention for Medicare and Medicaid claims in the seven (7) Southwestern Jurisdiction states of Colorado, New Mexico, Oklahoma, Texas, Arkansas, Louisiana and Mississippi.
The work performed by Qlarant includes: developing provider and supplier risk assessments and predictive models for CMS and sharing this information with CMS partners; providing Medicare and Medicaid standards education to providers; providing detailed pre-pay and post-pay medical review on aberrant providers; performing data analysis and comprehensive claim review; conducting independent investigations to identify instances, indicators and patterns of suspected fraud and abuse or patient harm; and providing subject matter expertise in Medicare and Medicaid laws and regulations.
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External Data Analysis Request for Information (RFI)
