Our Solutions - Sentinel - Claims Integrity
Ensure claims are billed correctly and abide by the Medicare, Medicaid, and commercial policies through AI-powered investigative agents that understand Medicare policies and uncover fraud, waste, and abuse. Our agents analyze vast amounts of data across internal datasets, digital footprints, and public records to deliver comprehensive investigation reports in hours instead of days.
The Challenge - FWA Detection Is Overwhelming
Healthcare organizations lose billions annually to fraud, waste, and abuse. Traditional detection methods can't keep pace with evolving schemes, and manual investigations take weeks, time that sophisticated bad actors use to their advantage.
Data Overload
Claims data is vast and complex. Finding suspicious patterns among millions of transactions requires resources most organizations simply don't have.
Slow Investigations
Manual investigations take weeks of analyst time, cross-referencing databases, reviewing records, and compiling reports. By then, the damage is done.
Evolving Schemes
Fraudsters constantly adapt. New billing schemes, provider networks, and exploitation tactics emerge faster than rule-based systems can be updated to catch them.
Key Features - AI-Powered Fraud, Waste, and Abuse Detection
Sentinel combines advanced AI agents with deep Medicare policy expertise to detect improper billing patterns, investigate suspicious providers, and protect your organization from fraud, waste, and abuse.
- Advanced pattern detection across utilization, billing, provider networks, and emerging fraud schemes
- Smart workflows enabling rapid intervention and program optimization
- Proactive monitoring with risk scoring and clinical review integration
- End-to-end case management from alert to resolution with proven impact metrics
AI Investigation - Three Pillars of FWA Research
Our AI agents orchestrate comprehensive investigations across three distinct data pillars, delivering investigation reports in hours that would traditionally take days or weeks.
Internal Datasets
Analyze utilization patterns, provider affiliations, unbundling practices, high-cost procedures, peer comparisons, and payment velocity from your claims data and proprietary sources.
Digital Footprint
AI-powered web crawling examines customer reviews, legal case history, ownership trails, professional networks, news mentions, and social media presence for comprehensive provider profiles.
Public Records
Leverage CMS provider enrollment data, HHS-OIG exclusion lists, state licensing boards, DEA registrations, and other government databases to uncover regulatory red flags.
Benefits - Why Choose Sentinel
Sentinel transforms fraud investigation from a manual, time-intensive process into an AI-powered system that catches more fraud faster while freeing your team to focus on high-value work.
Faster Investigations
What once required multiple analysts working for days can now be accomplished in hours, with more comprehensive coverage and fewer missed connections.
Comprehensive Coverage
AI agents consistently find 80-90% of relevant signals across all three data pillars, often discovering connections human investigators would miss.
Actionable Intelligence
Move beyond general answers to specific, quantified risk assessments with investigation-focused responses and actionable next steps.
Proven Outcomes - Measurable Impact on Your Bottom Line
Organizations using Sentinel see measurable improvements in fraud detection, investigation efficiency, and cost recovery. Our AI agents deliver results that directly impact your financial performance.
Hours
vs. Weeks for Investigations
80-90%
Signal Coverage Across Data Pillars
3x
More Cases Reviewed Per Analyst
Data Integration - Accepted Data Sources
Sentinel integrates seamlessly with standard healthcare data formats, enabling rapid deployment without complex data transformation requirements.
- X12 837 (Claims)
- BCDA API
- CCLF
- ADT
Learn More - Deep Dives on Claims Integrity
Explore our technical blog posts to understand how Sentinel's AI-powered approach transforms fraud, waste, and abuse detection.
Three Pillars of Data for FWA Research
How AI agents transform healthcare fraud investigation by orchestrating specialized sub-agents across internal datasets, digital footprints, and public records.
Read articleBridging General Intelligence to Actionability
Making AI actually useful for healthcare fraud investigation through domain-specific tools and Medicare policy expertise.
Read articleDigging Up Signal from the Noise
How real-time utilization tracking and dynamic service grouping can help identify FWA patterns and save your MLR.
Read articlePricing - Tailored to Your Organization
Sentinel pricing is customized based on your organization's size, data volume, and specific needs. Contact us for a personalized quote and demo.
Enterprise Solution
Get comprehensive FWA detection capabilities tailored to your organization's specific requirements.
- AI-powered investigative agents
- Three-pillar data analysis
- End-to-end case management
- Concierge-level support
- Continuous updates and improvements
Ready to put an AI co-analyst to work for your team? Let's talk.
Our offices
- Palo Alto, CA
Corporate HQ - Atlanta, GA
Technology Branch