Healthcare Compliance

LMI has supported compliance oversight for six CMMI models:

• Comprehensive Primary Care Plus (CPC+),
• Comprehensive End-Stage Renal Disease Care (CEC),
• Accountable Care Organization Investment Model (AIM),
• Pioneer ACO, 
• Next Generation ACO, and
• Advance Payment.

Among its program integrity responsibilities, LMI audits the CPC+ model, which consists of nearly 3,000 primary care practices in 18 regions, and performs scheduled and ad hoc auditing for CEC and Next Generation ACO model participants.

LMI analyzed and monitored compliance of over 5,000 care plans for the MA program, which covers more than 20 million beneficiaries. LMI built an integrated suite of in-house systems and customized tools to perform qualitative and quantitative analyses of each plan. LMI’s approach has accelerated processing of repetitive requests, enabling customers to spend more time and resources on time-sensitive and emerging benefit policy issues. With over two decades of experience in supporting MA across seven divisions, LMI’s analyses inform updates on the health of the program to external stakeholders and afford insight into program improvements.

LMI’s health policy experts have drafted and cleared sections of proposed and final rules, prepared reports to Congress, and presented detailed accounts of model performance and program findings to external stakeholders on behalf of several CMS customers, including CMMI, the Center for Consumer Information and Insurance Oversight, Medicare Advantage, and the Medicare Shared Savings Program.