North Carolina
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South Carolina
Nominate a physician, and they could win $2,500 for a charity of choice!
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Services
External Quality Review
CCME provides external quality review to ensure Medicaid recipients receive high-quality, accessible, and timely care. As a multi-state External Quality Review Organization (EQRO) we partner with state agencies and health plans to provide best practice solutions to improve system performance and patient care.
Fraud Waste and Abuse Services
Medicaid programs provide valuable services to a state's citizens - but they are unfortunately targets for financial abuse and exploitation. We evaluate the integrity of payers and providers practices to ensure citizens receive the most value from their programs.
Quality Improvement
We work closely with clients to identify gaps and risks in health care system delivery and provide the tools, strategy and operational framework necessary to take action, driving tangible results at the citizen, provider, agency and community levels.
Utilization Management
We offer expert-level review and clinical analysis of medical records and information to make determinations about the appropriateness and necessity of health care services. Our staff of licensed professionals use our proprietary technology to deliver reliable and defendable decisions to ensure that resources are used judiciously in meeting the needs of patients.
Key Outcomes
12K+
ADMISSIONS AVERTED
Hospital admissions averted by increasing vaccinations during a five-year Provider and Practice Transformation program in South Carolina, resulting in more than $97 million in cost avoidance.
228M
TAX DOLLARS SAVED
Taxpayer dollars saved from going to fraud, waste or abuse during a 10-year Investigative Audit program with North Carolina aimed at protecting the integrity of the Medicaid program, citizens lives, providers and communities. For every $1 spent on the program, NC Medicaid saved $7.
777
DRUG EFFECTS AVOIDED
Adverse drug effects avoided by driving effective patient-centered communication during a five-year Provider and Practice Transformation program with South Carolina.
Key Outcomes
12K+
ADMISSIONS AVERTED
Hospital admissions averted by increasing vaccinations during a five-year Provider and Practice Transformation program in South Carolina, resulting in more than $97 million in cost avoidance.
228M
TAX DOLLARS SAVED
Taxpayer dollars saved from going to fraud, waste or abuse during a 10-year Investigative Audit program with North Carolina aimed at protecting the integrity of the Medicaid program, citizens lives, providers and communities. For every $1 spent on the program, NC Medicaid saved $7.
777
DRUG EFFECTS AVOIDED
Adverse drug effects avoided by driving effective patient-centered communication during a five-year Provider and Practice Transformation program with South Carolina.
News Highlights
5/16/2023
The Carolinas Center for Medical Excellence (CCME) is pleased to announce the appointment of Richard Mennuti, MBA, as Associate Vice President, Fraud, Waste, and Abuse (FWA). Richard will drive the development of CCME’s FWA Solutions program, including policies, procedures, and structure. He will also contribute to business development, working to expand and develop a full spectrum of FWA Solutions, and assist with data and reporting, professional publications, and client engagement.
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4/3/2023
North Carolina and South Carolina nonprofits can apply now for funding for projects that improve health care outcomes for individuals and communities
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4/3/2023
Do you know an outstanding North Carolina physician leader? Nominate them to win $2,500 for a charity of their choice!
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4/3/2023
Do you know an outstanding South Carolina physician leader? Nominate them to win $2,500 for a charity of their choice!
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