THE PROBLEM WE SOLVE
Providers who are non-operational hold active billing authority. Entities controlled by excluded or sanctioned individuals operate under nominee ownership arrangements that pass standard LEIE screening. High-risk provider types cluster at shared addresses with undisclosed common ownership. And the providers most likely to commit fraud are the ones who understand the oversight model well enough to stay just below its detection threshold.
Our Program Integrity services are built to close that gap. We combine field-proven site verification operations with multi-layer data analytics and the regulatory expertise to convert findings into enforcement actions. The result is not a report. It is a cleaned network, a documented action, and a provider population that knows someone is looking.
The core principle: Enrollment data is a snapshot in time. Field presence is what makes it current. When someone actually goes to the door — systematically, unannounced, across an entire provider category — a significant share of enrolled providers are consistently found not where they say they are, not doing what they claim to be doing, or not who they represented themselves to be when they enrolled. |
