Our proprietary application is used to support audits of providers, contractors and beneficiaries. The application generates sets of audit and fraud exceptions that are run against medical claims, pharmacy claims and eligibility data. Our solutions include advanced provider surveillance resulting in monitoring potential fraud schemes and providing support for investigations and law enforcement.

Program includes:

• Detection and reporting of fraudulent billing practices by providers.
• Identification of overpayments by providers through abusive billing practices.
• Cost avoidance through provider education and enhanced system edits.
• Supports investigations and fraud units.