Program Integrity

Protect against fraud and abuse.

With rising Medicaid expenditures, it’s more important than ever to ensure taxpayer dollars are spent appropriately on delivering quality, necessary care and preventing fraud, waste, and abuse. MedeAnalytics Program Integrity enables you to monitor your data to identify anomalies and emerging patterns that might indicate improper billing, duplicative care, prescription drug abuse, eligibility fraud, and more. This COTS solution supports identification, audit workflows, investigation, and enforcement actions.

  • Monitor and proactively identify anomalies in billing patterns and beneficiary utilization

  • Track prescription activity to detect drug seekers, opioid abusers, and other medication misuse

  • Streamline case management from case inception to completion

  • Identify over-treatment and duplicative services

  • Determine the need for formal review of long-term care claims

  • Aggregation

    Predictive analytics and executive dashboards enable proactive oversight and help you protect against fraudulent eligibility activity, duplicative care, prescription abuse, and more.

  • Interpretation

    Tools like network graph analytics enable you to pinpoint clusters of high-risk activity.

  • Transformation

    Case management workflows enable you to act on fraud and abuse efficiently and without the need for additional staff

Identify anomalies in the behavior of your providers and beneficiaries

Identify anomalies in the behavior of your providers and beneficiaries

Assess and balance workload across all Program Integrity staff

Assess and balance workload across all Program Integrity staff

What It Offers

  • Identification of fraud and abuse to contain costs and protect against risk
  • Predictive analytics, executive dashboards, case management, and geo-spatial analysis
  • Configurable dashboards that highlight anomalies and patterns of possible fraud and abuse
  • Case management workflows to streamline fraud and abuse management
  • COTS criteria to qualify for federal matching funds
Questions? Talk to one of our experts. Contact us