Detect and prevent fraud, waste, and abuse by identifying problem areas and patterns.

Analyze providers, eligibility, pharmacies, members, claims, and encounters for suspicious activities.

Validate identities, verify eligibility, and identify emerging fraud schemes.

Program data and 3rd party data are ingested and run through procedural and prediction models to detect previously known and unknown bad actors, schemes, and patterns. Data is vetted prior to analysis with our proprietary data profiler tool and assessed for completeness, efficacy, consistency, and usefulness.

Pondera’s SIU provides day to day support and training as well as deep-dive investigations into complex schemes and networks. Our subject matter experts include former FBI, program integrity chiefs, Inspectors General, certified fraud examiners, Medicaid and health plan investigators, and more.

Fully-integrated investigative case management imports cases from the fraud detection module or other sources and uses workflow and rules engines to route cases through your resolution process. The mobile application allows field investigators to review, record, and track cases while in the field.