Payment Integrity Platform

MMAC

CareSource Revamps FWA Detection with Advanced AI Analytics

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FRAUD DETECTION Over $1.6 Million in Billing Irregularities Discovered Challenge: Strengthening SIU Operations to Combat FWA CareSource, a leading managed care organization offering Medicaid, Medicare Advantage, and Marketplace plans, faced escalating challenges in detecting and preventing fraud, waste, and abuse (FWA) across its diverse lines of business. With rising healthcare costs and increasingly sophisticated fraudulent […]

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Missouri Medicaid Audit & Compliance Transforms FWA Detection Strategy & Results

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FRAUD DETECTION AI-Powered Analytics Yields $50 Return for Every $1 Spent Challenge: Tackling Rising Costs and Fraud in Medicaid The Missouri Medicaid system, serving 1.3 million residents and processing over 100 million claims annually, faced mounting pressure to control costs and improve the detection of fraud, waste, and abuse (FWA). Medicaid spending in Missouri exceeded

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