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Health Data & Program Integrity

Protecting federal health dollars starts with the data behind them.

Medical record review, healthcare data analytics, and program integrity support for the agencies responsible for Medicare, Medicaid, and the health programs millions of Americans depend on.

Program integrity is a data problem before it is a payment problem.

Health data and program integrity work in federal agencies comes down to volume. Millions of claims, records, and provider files move through these programs every day, and somewhere inside that volume are the coding that does not match the documentation, the enrollment that should have been flagged, and the payments that should never have gone out the door.

Catching those things takes two capabilities working together. You need clinical judgment close enough to the record to know what the documentation actually supports. You also need analytics wide enough to see the pattern across the whole population, not just the file in front of you. Most contractors bring one or the other.

Visual Connections brings certified coders, clinical reviewers, data scientists, and program managers to the same problem. The result is money protected, findings that hold up under scrutiny, and program leaders who can show their work when oversight asks.

From the record to the recommendation.

Medical Record Review, Analysis, and Coding

Certified coding experts working in ICD-10-CM, CPT, HCPCS, APC, DRG, RADV/HCC, and HEDIS, applying AHA Coding Clinic guidelines to complex records at federal program scale.

Clinical Integrity, Medical Necessity, and Utilization Review

Evaluating documentation against coverage and necessity standards for determinations that hold up the first time.

Healthcare Data Analytics and Program Integrity Analysis

Statistical models and predictive analytics that surface improper payment risk, provider outliers, and enrollment anomalies before payment goes out.

Program Auditing and Corrective Action Support

Structured audit support, milestone tracking, and standard operating procedures for programs operating under oversight findings and corrective action plans.

Synthetic Data for Training and Readiness

Realistic, non identifying datasets that let teams train models, test systems, and run readiness exercises without exposing protected health information.

Acquisition Benchmarking and Stress Mapping

Benchmarking program and acquisition performance to show where capacity is thin, where cost is drifting, and where the next failure point is likely to be.
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Built for the programs where a wrong answer becomes a finding.

We are a minority owned, Service Disabled Veteran Owned Small Business and an SBA certified HUBZone Small Business, headquartered in Columbia, Maryland. Since 2007 we have supported federal health programs at CMS and across HHS, including medical record review, provider screening and enrollment support, and program integrity analysis.

That work is on the record. Our performance on Medicare and Medicaid provider screening and program assurance contracts has been documented in CPARS by our government customers, including work stood up specifically to close an OIG corrective action.

We also hold CMMI Level 3 appraisals and ISO certifications across five standards, and we are active on GSA MAS, GSA VETS 2 GWAC, CMS SPARC, and VA T4NG2.

If the data is already there, the answers should be too.

Let’s talk about where your program integrity gaps are, what your current review process is missing, and what it would take to close it.

Frequently Asked Questions