Fraud Solutions Index

NHCAA's Platinum, Premier and Supporting Members are leading providers of products & services to the health care anti-fraud industry, are valued partners who support our mission, and have demonstrated outstanding commitment to the fight against health care fraud.


Change Healthcare
3055 Lebanon Pike
Nashville, TN 37214

Phone: 615.932.3000

Change Healthcare

Change Healthcare is a leading provider of software and analytics, network solutions and technology-enabled services all designed to enable smarter healthcare. By leveraging our Intelligent Healthcare Network the single largest financial and administrative network in the United States healthcare system – payers, providers and pharmacies are able to improve efficiency, reduce costs, increase cash flow and more effectively manage complex workflows. Learn more at

Cotiviti (formerly Verscend Technologies)
10897 S. River Front Pkwy
Suite 200
South Jordan, UT 84095

Phone: 866.269.0238


Following the Verscend-Cotiviti combination, Cotiviti will be a leading information technology and analytics company that is reshaping the economics of healthcare, helping its clients uncover new opportunities to unlock value. Cotiviti's solutions are a critical foundation for healthcare payers in their mission to lower healthcare costs and improve quality through higher performing payment accuracy, quality improvement, risk adjustment, and network performance management programs. The company also supports retail and life/legal industries with data management and audit services that improve business outcomes. For more information, visit

695 E Main St. 6th floor
Stamford, CT 06901

Phone: (203) 905-2854


Deloitte’s Program Integrity for health care solution (Program Integrity) is changing the way organizations approach improper payment prevention and recovery. Program Integrity brings together data scientists, health care specialists, and the latest in forensic and analytic technology to provide payers with solutions designed to effectively analyze claim payments and enable actionable evidence-based decisions. Program Integrity is informed by the global scale of our anti-fraud and improper payment prevention experience and leverages our distinct managed services operating platform and delivery model. Learn more about Program Integrity for health care.

75 5th St NW, Ste 2130
Atlanta, GA 30308

Phone: 770-547-8798


FraudScope is an AI-assisted platform that accelerates the identification of fraud, waste, and abuse. Our comprehensive claims investigation platform utilizes proven and patented AI-based technology to empower investigators and analysts to derive insights and conduct full investigations of suspect claims. Some of the unique benefits of FraudScope's offering are as follows:

  1. Smarter Investigation - Intuitive, easy-to-use investigative tool suite enhances productivity by speeding up investigations
  2. Better Detection - Proactive AI automatically identifies fraud schemes, including new and emerging ones, with low false positives before claims are paid
  3. Easier Collaboration - Integrated workflow and case management supports collaboration and sharing across the organization

Healthcare Fraud Shield
16052 Swingley Ridge Road
Suite 200
Chesterfield, MO 63017

Phone: 888.333.8140


Healthcare Fraud Shield provides new and unique Fraud, Waste and Abuse (FWA) automated solutions to the healthcare industry. Our exclusive data solutions and investigative expertise deliver maximum results in the detection and prevention against fraud. Leveraging our comprehensive fraud experience, we deliver fresh insights and new approaches to combat the largest challenge of our time - the delivery of honest, efficient and compassionate healthcare.

Healthcare Fraud Shield offers a fully integrated Fraud, Waste and Abuse software solution platform called FWAShieldTM that includes PreShieldTM (A pre-payment detection system), PostShieldTM (A post-payment detection system), QueryShieldTM (An ad-hoc querying tool) and CaseShieldTM (A case management system that works cohesively with PreShieldTM, PostShieldTM and QueryShieldTM).

5615 High Point Drive
Irving, TX 75038

Phone: 214.453.3000


HMS is a leading healthcare technology company, helping healthcare organizations reduce costs and improve health outcomes. Our innovative technology, analytics and engagement solutions save billions of dollars annually while helping health plan members lead healthier lives. HMS provides a broad range of coordination of benefits, payment integrity, care management and member engagement solutions that help move the healthcare system forward.

16 Crosby Dr.
Bedford, MA 01730

Phone: 781-895-3118


MultiPlan offers a total healthcare cost containment solution that includes payment integrity, network-based and analytics-based services, helping payers reduce the cost of care and improve competitiveness. Unlike similar products, MultiPlan's payment integrity services include a personal review by an experienced clinician in addition to automated reviews. This human touch allows us to catch more complex issues indicative of waste and abuse, that go undetected by other products. For over 30 years, we've processed claims prepayment. Today almost 1 million providers participate in our networks, partnering with us to control claim costs. This rich history helps us resolve payment integrity issues quickly while minimizing provider abrasion --- all before our clients pay a dime.

13625 Technology Drive
Eden Prairie, MN 55344

Phone: 800.765.6807


Optum is a leading health services and innovation company dedicated to helping make the health system work better for everyone. With more than 85,000 people worldwide, Optum combines technology, data and expertise to improve the delivery, quality and efficiency of health care. Optum uniquely collaborates with all participants in health care, connecting them with a shared focus on creating a healthier world. Hospitals, doctors, pharmacies, employers, health plans, government agencies and life sciences companies rely on Optum services and solutions to solve their most complex challenges and meet the growing needs of the people and communities they serve.

100 Campus Dr
Cary, NC 27513

Phone: 919.677.8000


SAS is the leader in advanced analytics software and services, and the largest independent vendor in the business intelligence market. With SAS® payment integrity solutions, health care organizations can detect suspicious activity, prevent improper payments, and uncover collusion and multiparty fraud schemes. Since 1976, SAS has given customers around the world THE POWER TO KNOW®.

Shift Technology
75 Federal Street, 18th Floor
Boston, MA 02110

Phone: 1.860.227.5173


Shift Technology delivers an AI-native fraud, waste and abuse detection solution designed to meet the evolving needs of the global health insurance industry. Our SaaS solutions identify suspicious claims activities related to providers, networks and other parties with double the accuracy of competing offerings. To date, Shift has analysed more than one billion claims for leading insurers around the globe enabling faster, more accurate claims resolutions while helping to eliminate fraud, waste and abuse. Learn more at

Truven Health Analytics, an IBM Watson Health Company
777 Eisenhower Parkway
Ann Arbor, MI 48108

Phone: 734.913.3432


IBM Watson Health™ helps state Medicaid programs and federal agencies manage healthcare quality and ensure program integrity. With broad fraud-fighting experience, our unique combination of data-driven enterprise transformation and advanced analytics can help you fight healthcare fraud, waste and abuse at every stage. Our suite of program integrity analytics, tools, and services includes identity verification & enrollment, pre- & post-payment analytics, investigative support, and audit & recovery. For more information, visit:



CGI Federal Inc.
1001 Lakeside Avenue
Suite 800
Cleveland, Ohio 44114-1151

Phone: 410.279.0996

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CGI, a global IT and consulting company, is an industry leader in identifying improper payments and assisting healthcare payers to control costs. Our fraud, waste and abuse solution, ProperPay, includes data mining functionality, algorithms and edits to identify improper payments and other features that increase efficiencies in the audit and recovery process.
433 South Main Street
Suite 203
West Hartford, CT 06110

Phone: 1.800.653.3144


SCIO Health Analytics, an EXL company, is a leading health analytics solution and services company. It serves over 100 healthcare organizations representing over 130 million covered lives across the continuum including providers, health plans, PBMs, employers, health services and global life sciences companies.

SCIO provides predictive analytics and insights as a service to transform data into actionable insights, helping healthcare organizations identify opportunities and prescribe actions to drive operational performance and address the healthcare waste epidemic while improving care quality. SCIO is dedicated to helping our clients achieve optimal outcomes and decrease the total cost of care. For more information visit:



500 North State College Blvd
Suite 900
Orange, CA 92868

Phone: 610.727.7000


AmerisourceBergen is a leading global healthcare solutions company. The company drives innovative partnerships with pharmacies, health systems, practices and manufacturers to improve product access, increase supply chain efficiency and enhance patient care. Customers count on AmerisourceBergen for comprehensive services and solutions across the healthcare supply chain - from commercialization and distribution to pharmacy, health system, practice and manufacturer solutions. The company's extensive knowledge, global reach and innovative partnership philosophy enable them to help customers capitalize on the dynamic changes in healthcare. With more than $120 billion in annualized revenue, AmerisourceBergen is the leader in global sourcing and distribution and employs approximately 16,000 employees worldwide from their headquarters in Conshohocken, PA. AmerisourceBergen. Where knowledge, reach and partnership shape healthcare delivery. For more information, visit

Context 4 Healthcare, Inc.
55 Shuman Blvd., Ste 650
Naperville, IL 60563

Phone: 800-783-3378


Context 4 Healthcare is the leading provider of cloud-based healthcare compliance solutions in verifying medical claim accuracy for health plans and benefits administrators. These solutions are designed to review for complex coding accuracy, identification of potential fraud, waste, and abuse (FWA) situations before the claim is paid, and to review for potential FWA situations in claim history. Context's Medical Director and our team of certified claim experts maintain solution rules weekly for up-to-date compliance and identification of potential new FWA schemes. The semi-annual creation of our proprietary UCR fee schedules is also a source for identifying potential FWA situations leading to new solution rules, a capability unique to Context. Our experts also blog for your benefit, letting you know about emerging situations that may affect your compliance, and what Context is doing about it. Since 1988, Context has been the healthcare industry's leading compliance specialist.

475 Anton Blvd.
Costa Mesa, CA 92626

Phone: 714.830.7000


Experian unlocks the power of data to create opportunities for consumers, businesses and society. At life's big moments - from buying a home or car, to sending a child to college, to growing a business exponentially by connecting it with new customers - we empower consumers and our clients to manage their data with confidence so they can maximize every opportunity.

We gather, analyze and process data in ways others can't. We help individuals take financial control and access financial services, businesses make smarter decision and thrive, lenders lend more responsibly, and organizations prevent identity fraud and crime.

For more than 125 years, we've helped consumers and clients prosper, and economies and communities flourish - and we're not done.

Our 17,000 people in 37 countries believe the possibilities for you, and our world, are growing. We're investing in new technologies, talented people and innovation so we can help create a better tomorrow.

2000 Purchase Street
Purchase, NY 10577-2509

Phone: 914.249.2509


Mastercard Healthcare Solutions provides a proven AI solution that differentiates by leveraging its experience in payment fraud to complement claim fraud mitigation. Mastercard Healthcare Solutions’ unique competency supports post-pay detection, while also creating prospective (pre-pay) models built by identifying anomalies found in historical claims data (post-pay). In this webinar, you will learn how you can increase detection of fraud, waste and abuse (FWA) before sending good money for bad claims, significantly reducing inefficient pay-and-chase activities while moving toward a prevent and save business model. With increased detection of true FWA, false positives are greatly reduced, anomaly detection is significantly increased, and payers can focus their investigators’ time on highly-likely FWA.

202 Burlington Rd
Bedford, MA 01730-1407

Phone: 781.271.2000


MITRE is a not-for-profit organization that operates research and development centers sponsored by the federal government.

We operate FFRDCs-federally funded research and development centers-which are unique organizations that assist the United States government with:

  • Scientific research and analysis
  • Development and acquisition
  • Systems engineering and integration

We also have an independent research program that explores new and expanded uses of technologies to solve our sponsors' problems.

MITRE's Sole Focus Is to Operate FFRDCs

MITRE is chartered to work in the public interest. We have no commercial interests. We have no owners or shareholders, and we can't compete for anything except the right to operate FFRDCs. This lack of commercial conflicts of interest forms the basis for our objectivity. We also have the ability to acquire sensitive and proprietary information from the government and industry to inform our work. These organizations are able and willing to share data because they know we won't use it for a competitive advantage.

Moreover, because we operate multiple FFRDCs, we foster a culture of knowledge sharing. We apply what we learn from addressing one sponsor's challenges to similar issues faced by other federal agencies. This means when sponsors engage with us, they have access to all the minds of MITRE.

Verisys® Corporation
1001 N. Fairfax Ave
Suite 640
Alexandria, VA 22314

Phone: 888.837.4797

Verisys NEW

Verisys® provides health care compliance professionals with the tools they need to prevent waste, abuse, and fraud committed by high-risk people, professionals, and businesses. We are the leading provider of sanctions, exclusions, and disciplinary actions. Our flagship product, FACIS®, offers a full complement of primary sources to monitor licensure, DEA, criminal, sex offender, abuse registries, and more.