Fraud, Waste & Abuse

Investigation. Intelligence. Integrity.

The most dangerous risks are the ones you never see coming. That’s where we come in. The Qlarant team is made up of real-world experts who know how to solve complex problems by combining human intelligence and advanced technology solutions to combat fraud, waste, and abuse. As federal agencies shift from reactive “pay-and-chase” models to proactive “caught and stopped” strategies, Qlarant is uniquely positioned to lead.

We provide a range of services for government and commercial clients, including auditing, monitoring and consulting. Our team is unmatched in predictive modeling and real-time risk assessment, enabling the identification of billing anomalies and suspicious patterns before disbursements occur. By deploying advanced AI-driven “detect and deploy” solutions, we help our partners stay ahead of bad actors and significantly reduce improper payments. Put our investigators and data scientists on your side to ensure program integrity through immediate, preventative action. Talk to one of our experts.

Qlarant identified over 5 billion dollars in fraud, waste, and abuse in a four year span

Fraud, Waste & Abuse Solutions

Pharmacy Solutions

With nearly 20 years of experience, Qlarant brings a wealth of expertise on Medicare Part D and pharmaceutical data analytics.

Predictive Modeling & Data Analytics

Qlarant uses proven algorithms and powerful data analytics to sift through billions of records to conduct risk assessments, detect aberrant trends, and alert investigators to potential fraud and abuse.

Investigations

Qlarant offers proactive and reactive criminal, civil and internal investigations. Our technology solutions identify risks. Subject matter experts know where to look. And “Jump Teams” help find the worst offenders quickly.

Audits

Learn about risks before they become problems. The Qlarant team uses rigorous processes to provide expert onsite audits of risk assessment, compliance, contract, financial, fraud, and performance.

Medical & Claims Review

Qlarant reviews claims and analyzes records to identify fraud, waste, and abuse, as well as billing, compliance and quality of care issues — protecting your organization and saving you money.

Hearings & Appeals

Qlarant’s renowned subject matter experts develop high-quality fraud case referrals, provide testimony, support appeals effectively and provide thoroughly documented work-products.

Compliance & Due Diligence

Use our compliance experts to help determine an organization’s adherence to industry laws and regulations — and to identify issues or other risks a prospective buyer might inherit.

Enrollment Monitoring & Analysis

Qlarant monitors and analyzes provider enrollment databases, searching for risk factors, investigation data, review findings and more — to identify low- to high-risk providers.

Call Center Management

We provide full-service bilingual call center activities for tracking, trending and investigating FWA issues. Work products are thoroughly documented, secure and readily retrievable.

Communication & Training

Let us train your staff on investigations, audits, and data analysis. We can also create customized training solutions in appeals strategy, medical review, data science and more.

hands holding a tablet with an unemployment form on it

Unemployment Fraud Solutions

Administrators and directors must constantly innovate and improve on the quality, integrity, and impact of their programs. Qlarant knows what it takes to identify fraudsters and sustain program integrity.

Transportation Fraud Solutions

In an industry defined by change, Transportation leaders need new solutions to ensure the integrity and success of their initiatives. Discover how Qlarant can improve quality, reduce risk, and get programs on the right track.

Pandemic Solutions

Qlarant offers proactive and reactive investigations to prevent or stop fraud related to outbreaks, epidemics, and pandemics. Using technology solutions and subject matter experts, we know where to look and what to look for to identify and stop fraud, waste, and abuse quickly.

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How can Qlarant help you combat fraud, waste and abuse?

Quality Improvement solutions are provided by Qlarant Quality Solutions, Inc., formerly Delmarva Foundation for Medical Care, Inc. Fraud, Waste, & Abuse solutions are provided by Qlarant Integrity Solutions, LLC, formerly Health Integrity, LLC. Data Sciences & Technology solutions may be provided by
Qlarant Quality Solutions, Inc., formerly Delmarva Foundation for Medical Care, Inc.
Qlarant Integrity Solutions, LLC, formerly Health Integrity, LLC, and/or
Qlarant Commercial Solutions, Inc., formerly Health Watch, Inc.

Fraud, Waste & Abuse

Investigation. Intelligence. Integrity.