Program Integrity

Our MedGuard® system of integrated software applications and services support health plan integrity functions to identify, recover, and prevent inappropriate payments for health care. These functions include detecting, investigating, and preventing fraud, waste, and abuse by health plan participants. MedGuard® uses a unique combination of formulas and clinical judgment to analyze claims and payment data to detect patterns of fraud or abuse. With MedGuard®, you never have to wonder if an honest mistake is costing you money or part of a larger integrity problem.