Fraud, Waste & Abuse Companies

Companies that manage fraud, waste, and abuse provide tools to help employers identify fraud, waste, and abuse in their healthcare costs.
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Personify Health

Personify Health

4.0 (98)
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Personify Health has developed a robust and sophisticated fraud prevention and recovery program. This program is built upon a combination of cutting-edge technology, extensive expertise, and strong partnerships. Continuous updates to our library... Show More
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6 Degrees Health

6 Degrees Health

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Founded

2012

Employees

141

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About 6 Degrees Health

6 Degrees Health is a service-first cost containment company. For many, we set care free from the constraints of traditional networks. For others, we bring integrity to historically opaque billing practices. For all, we leverage unparalleled clinical expertise and innovative data technology to empower employers and their covered employees in realizing the true benefit of healthcare.

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Case IQ

Case IQ

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Uncover, Investigate and Prevent Incidents and Misconduct

Case IQ is a powerful employee hotline and case management platform that streamlines your investigative process. Case IQ provides the data you need... Show More
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Cotiviti

Cotiviti

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Founded

2004

Employees

8,573

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About Cotiviti

Cotiviti is a leading solutions and analytics company that is reshaping the economics of healthcare, helping its clients uncover new opportunities to unlock value. Cotiviti’s solutions are a critical foundation for healthcare payers in their mission to lower healthcare costs and improve quality through higher performing payment accuracy, quality improvement, risk adjustment, and network performance management programs. The company also supports the retail industry with data management and audit services that improve business outcomes. Show More
Milu Health

Milu Health

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Milu's BillFighter tool flags medical bills with potential mistakes, notifies employees of these potential mistakes, and offers to dispute the bill on their behalf. Bills with mistakes are flagged from claims or EHR... Show More
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Prime Therapeutics

Prime Therapeutics

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Founded

1987

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None

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About Prime Therapeutics

Everything we do is connected to helping people get the medicine they need to feel better and live well. It’s meaningful work and we’ve been doing it for over 20 years.

In the pharmacy benefit management (PBM)industry, we’re different. We’re owned by 18 not-for-profit Blue Cross and Blue Shield health plans. This allows us to control costs and empower our employees to put members first. It’s a successful combination. We have the lowest pharmacy trend in the industry and serve 27+ million members throughout the US.

In addition to core PBM services, we... Show More
BMI Audit Services

BMI Audit Services

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100 eligible

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1,000,000,000

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See the description for Healthcare Claims Data Analytics Show More
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Alliant Health Solutions

Alliant Health Solutions

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Founded

1970

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About Alliant Health Solutions

Alliant Health Solutions is a nonprofit organization driven to make health care better in the United States by improving quality of care, increasing the value of health care, and promoting prevention and treatment for chronic illnesses. Our family of companies provide professional services to state, federal and private partners, supporting the effective administration of health care programs and improvement initiatives. Alliant has three primary lines of service offerings that leverage evidenced-based methods, data and technology, and clinical expertise
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First Healthcare Compliance

First Healthcare Compliance

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Founded

2012

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About First Healthcare Compliance

We help create confidence among compliance professionals through education, resources, and support in the areas of HIPAA, OSHA, human resources compliance, and fraud waste and abuse laws. Our flexible, scalable, secure, cloud-based software allow organizations to: Share, track, and manage their compliance processes with ease; View compliance status in real time, across all locations; Have peace of mind that they are current in all federal healthcare regulatory areas.
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Integrity Advantage

Integrity Advantage

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Founded

2017

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About Integrity Advantage

Integrity Advantage is the way healthcare payers reimagine the value of their fraud, waste and abuse program. We’ve built our diverse knowledge base through decades of doing. Our experience providing support to dozens of plans across all lines of business, geographical regions, and varying enterprise priorities give our clients a tremendous advantage. We are a vendor neutral trusted advisor, providing objective perspectives and offering solutions for real challenges faced by the payment integrity industry. We offer advisory consulting, strategic planning, detection, investigation, medical review and training services to support program integrity initiatives in the identification and prevention of healthcare fraud,... Show More
Qlarant

Qlarant

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Founded

1973

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About Qlarant

For 48 years, our history has been rooted in commitment to quality improvement for organizations — and quality of life for the people they serve. We began as Delmarva Foundation for Medical Care in 1973 on Maryland’s Eastern Shore as one of the country’s first quality review organizations for the Centers for Medicare and Medicaid. Through the decades, we created entities that became nationally known, including Delmarva Foundation, Health Integrity, and Quality Health Strategies. Today, we’ve brought together these extensive resources and the expertise of more than 500 professionals under one name — Qlarant — serving some of our nation’s... Show More
Zigron Inc.

Zigron Inc.

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Founded

2006

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About Zigron Inc.

Zigron was founded in 2006 by enthusiastic and dynamic gurus. Zigron specializes in Cloud and SaaS based solutions, Big Data Analytics, New Platform/Product Development, Rich User Experience, User Experience Modernization/Unification and Advanced Data Visualization in Telecom, Wireless, Broadcast, Satellite, M2M and Networks, SDN/NFV, Open stack, Cloud engineering, Cloud infrastructure management, DevOps, Data sciences and Automation testing .Over the last 10 years, Zigron has worked with more than 70 plus companies.
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360 Health Systems, Inc.

360 Health Systems, Inc.

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Founded

2014

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About 360 Health Systems, Inc.

We aim to empower Health Plans and Payor Healthcare Organizations with a unique, easy-to-use and unparalleled technology of tomorrow to catch improper claims payments. 360 Health System's digital and non-traditional approach enables you to take full control over your Payment Integrity Operations to meet and exceed your financial recovery objectives.
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ACS - Training & Technologies

ACS - Training & Technologies

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Founded

1970

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About ACS - Training & Technologies

Established in 1970, ACS is well established and reputed privately owned technology-enabled services and solutions company with advanced capabilities in training & consultancies, medical billing, medical transcription, and web and software services. We design and deliver quality training courses beyond what is expected by the customer at a competitive price.
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Alaffia Health

Alaffia Health

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Founded

2020

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About Alaffia Health

Alaffia Health is a healthtech company that uses machine learning and AI to identify and eliminate provider fraud, waste, and abuse in healthcare claims. We work with health plans, TPAs, self-funded employers, reinsurers, and government agencies to lower healthcare costs by eliminating overpayments.
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Barrow Wise Consulting, LLC

Barrow Wise Consulting, LLC

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Founded

2012

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About Barrow Wise Consulting, LLC

After gaining more than 20 years of expertise in IT consulting and building strong customer relationships across the private and government sectors, our Founder created Barrow Wise Consulting, LLC in 2012, with a commitment to learning from clients and delivering solutions that reduce costs, improve operational efficiencies, solve business challenges, and increase the value of IT investments. With transformative consulting and engineering solutions, Barrow Wise has helped secure the largest global cyber security program, transform the largest network, and strengthen the government’s most extensive payment system.
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Brighterion

Brighterion

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Founded

2000

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About Brighterion

Brighterion, a Mastercard company, was founded in 2000 and acquired by Mastercard in 2017. Building on our experience in preventing financial crime, Brighterion was engaged by Mastercard in 2006 to deploy our AI-based fraud solution for payments amongst its issuing banks. Mastercard integrated that technology across its Decision Intelligence platform in 2016.
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ClaimInformatics

ClaimInformatics

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Founded

2017

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About ClaimInformatics

At ClaimInformatics, we are dedicated to discovering and recovering improper payments on behalf of employers and administrators. We have designed a state-of-the-art, highly secure, HIPAA Compliant system that provides new levels of accuracy and transparency for improved payment integrity. This new platform has been designed to provide a granular forensic review of all healthcare claim transactions. We handle recovery and reconciliation of improper payments as well as detection of fraud, waste and abuse. Our process incorporates an end-to-end solution with corrective action plans. We have a continuous monitoring cycle and we deploy code auditing controls for pre-payment applications that favors... Show More
ClarisHealth

ClarisHealth

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Founded

2013

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About ClarisHealth

ClarisHealth challenges the status quo for all payment integrity services to develop and deliver the most exceptional and innovative technology solutions addressing the real industry challenges of today and tomorrow for health plans. What sets us apart? TOTAL PAYMENT INTEGRITY™ brings it all together. ClarisHealth is dedicated to transforming engagement across the healthcare continuum. Connecting payers, providers and business partners with a single technology platform designed to support transparent communication. It's payment integrity -- illuminated. Technology: It’s all too easy to get bogged down managing the day-to-day of internal versus third-party resources. Our innovative technology PAREO™ allows us to provide... Show More
Context 4 Healthcare, Inc.

Context 4 Healthcare, Inc.

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Founded

1988

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About Context 4 Healthcare, Inc.

Headquartered in the Chicago area, Context 4 Healthcare, Inc. has more than 33 years of experience in software & data products for healthcare compliance. Our solutions impact more than 4,000 clients & tens of millions of lives. Context’s solutions have been developed to address the industry challenges currently faced by healthcare payers & providers. Our cloud based Payment Integrity Platform utilizes our proprietary analytics engine to identify coding errors, medical necessity, unbundling, fraud-waste-abuse (FWA), audit risks and other aberrations that can impact your business. Context’s nationally recognized UCR (usual, customary and reasonable) fee database utilizes billions of provider transactions, providing... Show More

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