Our data scientists know where to mine to detect fraud, waste, and abuse.
Qlarant is a national leader in conducting quantitative and qualitative analytics to detect and prevent fraud, waste, and abuse. RIViR®, our data analytics and predictive modeling tool, was created based on Qlarant’s extensive experience working with states and federal agencies to battle fraud.
RIViR is a powerful engine that sifts through billions of records to detect aberrant trends and send alerts for early investigative and audit action. It is scalable and easily integrated with your data systems.
We’ve put our software and predictive modeling tools successfully to work at the national and local level:
- Qlarant served as the integrity contractor for the National Benefit Integrity Medicare Drug Integrity Contract (NBI MEDIC). During that program, our predictive modeling and data analytics software was used to detect and prevent fraud in Medicare prescription drug and managed care programs. The CMS, sponsors of the programs, and law enforcement use this application to identify fraudulent behavior and track outcomes.
- Qlarant also used our tools to assist the State of Delaware in evaluating its paid Medicaid claims to identify probable fraud and/or misuse of Medicaid dollars.
- Qlarant has also teamed with Northrop Grumman and IBM to develop new predictive modeling technology known as the Fraud Prevention System (FPS) to identify and stop payment on suspicious fee-for-service claims until they can be validated.
The algorithms designed, tested, and put to work by Qlarant data scientists have demonstrated a greater than 90% accuracy rating. This means that over 90% of the providers/suppliers identified were actionable leads. Talk to us and tell us how we can put RIViR and our expertise to work for you.