Integrity Modeling & Analytic Support Program

Qlarant supported the activities of IBM Corporation by providing Medicare claims and clinical subject matter expertise (SME) to support the National Fraud Prevention System (FPS), by implementing predictive models and edits to identify high-risk providers. As part of the IBM team, Qlarant performed extensive research and claims analysis in the development of algorithms (models), edits and studies in the detection and prevention of fraud, waste, and abuse to support program integrity investigations and administrative actions. The subject matter expertise provided by Qlarant in the area of Medicare policy included claims specialists, clinicians, and investigators to assist with efforts to strategically combat fraud, waste, and abuse across Medicare, Managed Care, Part D, and Medicaid programs.