Fraud, Waste & Abuse Data Intelligence
AI-powered anomaly detection, predictive risk scoring, and claims analytics for healthcare fraud detection and federal program integrity.
What We Deliver
Technical capabilities engineered for federal compliance, scalability, and measurable mission outcomes.
Predictive Risk Scoring
Machine learning models that score claims, providers, and beneficiaries for fraud risk in real-time, prioritizing investigative resources on highest-impact cases.
Anomaly Detection & Pattern Analysis
Unsupervised learning algorithms that identify aberrant billing patterns, provider networks, and beneficiary utilization trends across millions of claims.
Claims Analytics Platform
Enterprise analytics platform for Medicare, Medicaid, and commercial claims data with drill-down dashboards, trend analysis, and automated alerting.
Provider Network Analysis
Graph analytics and social network analysis to identify collusive provider networks, kickback schemes, and phantom billing operations.
Regulatory Compliance Reporting
Automated generation of OIG, CMS, and DOJ-required reports with audit-ready documentation, evidence packaging, and case management integration.
Recovery & ROI Analytics
Tracking and reporting of improper payment recoveries, cost avoidance metrics, and program integrity ROI to justify investment and demonstrate value.
Federal Use Cases
Real-world deployments across federal and state agencies demonstrating measurable outcomes.
Enterprise fraud detection across Medicare Parts A, B, C, and D — identifying $2B+ in improper payments annually through predictive analytics.
Medicaid program integrity solutions for state agencies with provider profiling, beneficiary eligibility verification, and pharmacy fraud detection.
Financial fraud analytics for Inspector General investigations with automated transaction pattern analysis and suspicious activity reporting.
Common Questions
We deploy supervised and unsupervised machine learning models trained on historical claims data to identify anomalous billing patterns, aberrant provider behavior, and suspicious beneficiary utilization in real-time.
Our platform detects upcoding, unbundling, phantom billing, identity theft, provider collusion networks, prescription drug diversion, and eligibility fraud across Medicare, Medicaid, and commercial programs.
Yes. Our solutions align with CMS Program Integrity requirements, OIG work plans, and the Fraud Reduction and Data Analytics Act (FRDAA) — providing audit-ready documentation and evidence packaging.
Federal agencies typically see 10:1 or higher return on investment through improper payment recoveries, cost avoidance, and reduced manual investigation time.