Sentinel Integrity Group

AI-Powered Fraud Prevention & Program Integrity

An HRN Group Division

$162B

Annual Improper Payments (GAO FY2024)

$2.8T

Cumulative Since 2003

50+

Fraud Vectors Monitored

68

Federal Programs at Risk

The Scale of Government Program Fraud

State agencies nationwide face unprecedented program integrity challenges

$162 Billion

The GAO estimates $162 billion in improper payments across 68 federal programs in FY2024 alone — $2.8 trillion cumulative since 2003. Five programs account for 75% of the waste: Medicare, Medicaid, EITC, SNAP, and pandemic-era spending.

Detection Gap

Manual auditing and sample-based reviews catch only 5-10% of fraud vectors. Traditional approaches operate on annual cycles while fraud happens in real-time.

Resource Crunch

State agencies face staffing constraints, budget limitations, and outdated tools across every program — Medicaid, SNAP, child welfare, workforce — while federal oversight demands continue to increase.

How We Solve It

Four capabilities that work across every funded program

Fraud Detection

  • 50+ fraud vectors across 8 program integrity lifecycle stages
  • AI pattern recognition on claims and payment data in real-time
  • Cross-program correlation across all state agencies
  • Risk scoring and prioritization by impact

Revenue Recovery

  • Underpayment detection and denial management
  • Fee schedule analysis and claims optimization
  • Contractor and MCO overpayment identification
  • Automated reconciliation workflows

Agency-Specific Oversight

  • Managed care, child welfare, SNAP, workforce, housing
  • Domain-specific detection models per program area
  • Contractor compliance and accountability monitoring
  • Provider/vendor fraud tailored to each program

Legislative Dashboards

  • Real-time program integrity metrics across all agencies
  • Legislator and agency leadership visibility
  • Proviso compliance monitoring
  • Quarterly reporting & audit-ready documentation

How We're Different

Purpose-built for state agencies and legislatures

The Traditional Approach

  • Annual or quarterly audits
  • Sample-based review (5-10% coverage)
  • Manual spreadsheet auditing
  • Reactive response (after fraud occurs)
  • Requires new appropriation
  • Long implementation (6-12 months)

Sentinel Approach

  • Real-time, continuous monitoring
  • 100% claims analysis across all stages
  • AI-powered pattern detection
  • Preventive (fraud stopped before payment)
  • Proviso-funded (no additional budget)
  • Live in 2 weeks

Real-Time Program Integrity Dashboard

See exactly what's happening across every funded program

Program Integrity Executive Dashboard

Current Month | All States
847
Fraud Alerts
$12.4M
At-Risk Amount
92%
Detection Rate
18
Unique Vectors
Fraud Vectors Detected (by category)
Recovery vs. Prevention Split
Prevention: 65%
Recovery: 35%

Powered By National Data

We process and correlate data from the most authoritative sources

CMS Medicare & Medicaid
HHS OIG Inspector General
State Agencies All 50 States
GAO Accountability Office
EDI & Claims 837 / 835 / HL7
Public Data IRS 990 / SAM.gov

3-Layer AI Architecture

From raw data to actionable intelligence in real-time

Layer 1: Data Ingestion

Standardized intake of claims, eligibility, enrollment, and policy data in any format (837, HL7, CSV, EDI). Secure SFTP with encryption. No system integrations required.

Layer 2: AI Detection Engine

50+ vector fraud detection matrix applied across 8 program integrity lifecycle stages. Machine learning models updated weekly. Real-time risk scoring and cross-program pattern correlation.

Layer 3: Oversight Dashboard

Executive reporting for legislators and agency leadership. Audit trails, compliance documentation, quarterly reporting. Everything states need for federal oversight and legislative accountability.

Ready to Protect Your Programs?

State and federal agencies nationwide are deploying Sentinel to detect fraud in real-time, protect program integrity across every funded program, and meet oversight requirements. Schedule a demo to see how we can serve your agency.

Schedule Your Demo