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iii. Government Programs
Program integrity is a data problem before it’s a legal one. We work both.
Program integrity, modernized.
Program integrity, modernized.
Government program-integrity teams are under pressure to find and recover improper spending at scale — Medicaid improper payments rose to $37.39 billion (6.12%) in FY2025, with more than three-quarters from insufficient documentation. The bottleneck isn’t finding anomalies; it’s turning data into citation-grade, defensible findings that hold on appeal.
The engagement
Citation-grade investigative findings; quantified, defensible recovery support; expert testimony; and analytics that surface the pattern, not just the claim.
Week 1 — intake: data, mandate, and target posture. Weeks 2–4 — outlier identification and record review. Ongoing — investigation, case development, and recovery or referral support.
Regulatory context
Federal policy is pushing program data together: Executive Order 14243 (eliminating information silos) and DOJ’s Health Care Fraud Data Fusion Center (June 2025) aggregate Medicare, Medicaid, and private data for cross-program detection. Medicaid’s own improper-payment rate stands at 6.12% ($37.39B) for FY2025, roughly 77% from insufficient documentation. The mandate is data-to-recovery — and the recovery has to survive appeal.
Frequently asked
Do you support state Medicaid agencies and MFCUs?
Yes — program integrity, FWA investigation, and recovery support, with licensed investigative authority.
Can your findings support enforcement?
Yes — citation-grade and exhibit-ready, with experts who testify.
How do you use data?
We surface outliers and patterns the way modern integrity programs do, then build the defensible case behind them.
Are you a law firm?
No. We’re the methodology bench — expert consultants and licensed investigators who build findings your agency counsel can take to hearing. Nothing here is legal advice.
30 minutes. No pitch. We open the case file together — and recommend the next step.