Solutions

Customized and Actionable


We partner with State Medicaid agencies to maintain program integrity and prevent payment of claims to providers with potentially fraudulent billing practices by examining claims prior to payment. We work to ensure that program dollars are not diverted, and that health and welfare of citizens is safeguarded.

  • Clinical Claims Review
    • Prepayment Claims Reviews
    • Post-payment Reviews
    • Claims on Review
    • Targeted or Ad Hoc Reviews
  • Paper Trail Analytics™
  • Special Investigative Unit (SIU) Services
  • Program Integrity Consultation including Staff Augmentation
  • Document Management, Extraction & Analysis Services

Outcomes

228M

TAX DOLLARS SAVED

$228M saved from going to fraud, waste or abuse during a 10-year investigative audit program with North Carolina

20%

20% REFERRAL RATE

More than 1 in 5 Medicaid Network providers we review are referred for potential program fraud or abuse or recipient abuse or exploitation. This work represents over 65 million dollars in Medicaid billings.

8:1

Return on Investment

8-to-1 ROI over a decade

Outcomes

228M

TAX DOLLARS SAVED


$228M saved from going to fraud, waste or abuse during a 10-year investigative audit program with North Carolina

20%

20% REFERRAL RATE


More than 1 in 5 Medicaid Network providers we review are referred for potential program fraud or abuse or recipient abuse or exploitation. This work represents over 65 million dollars in Medicaid billings.

8:1

Return on Investment


8-to-1 ROI over a decade


Customers

Decades of experience


We apply decades of experience understanding agency needs and healthcare realities working hand-in-hand with Program Integrity staff at State Medicaid agencies and other healthcare plans.