The Medicaid integrity platform that combines multiple years of national claims intelligence, real-time federal database validation, and IG-audit-grounded fraud vector mapping to hold MCOs accountable and prevent fraud before it happens.
Sentinel Integrity Group exists because IG audits keep documenting the same problems and agencies keep acknowledging them without acting. State oversight bodies routinely find hundreds of millions of dollars in MCO overpayments. Recoveries lag identification by years, or never happen at all. The problem isn't a lack of fraud. It's a lack of intelligence infrastructure to prove it, operationalize it, and hold MCOs accountable.
We built Sentinel to close that gap. By integrating 150M+ Medicaid claims with four prime federal databases (CMS Coverage Determinations, ICD-10, the NPI Registry, and PubMed), we transformed program integrity from pattern detection into a federal-evidence-backed accountability engine. Every MCO denial can now be validated against the federal coverage rule that governs it. Every fraud vector is mapped to an IG audit finding. Every finding is provable.
Sentinel is not a traditional auditor. Sentinel is not a generic software vendor. Sentinel is the analytics layer that turns statutory authority into operational accountability, purpose-built to ensure Medicaid dollars reach the people they were intended for, not the entities gaming the system.
Backed by operational depth in healthcare program integrity and state government services.
High Value Change is Sentinel's parent organization. Founded by David Thorne, High Value Change builds the analytical infrastructure that state oversight bodies, federal review contractors, and managed-care oversight teams use to turn statutory authority into operational accountability.
Sentinel Integrity Group is the Medicaid program integrity intelligence division. Sister capabilities span healthcare revenue recovery, state program operations support, and federal contractor analytics.
Every alert is audit-ready. Sentinel builds trust through transparency and documentation that stands up to federal oversight and legislative scrutiny.
Sentinel monitors 36 vectors across 8 lifecycle stages. Models are updated continuously. We stay ahead of fraud patterns so states don't fall behind.
States understand why we flagged each claim, which regulation it violated, and what evidence supports our findings. Full audit trails and compliance documentation provided.
Sentinel applies AI and data science to a sector that has not seen serious technology investment. Real-time processing. Cross-program correlation. Predictive risk scoring.
David Thorne is the founder and CEO of Sentinel Integrity Group, a Division of High Value Change. He leads Sentinel's Medicaid managed-care program integrity platform, holding MCOs accountable to the federal coverage rules that govern the services they are paid to deliver. A graduate professor of Digital Transformation at Wichita State University's Executive MBA program, David developed the DDR (Discovery, Diagnostics, Roadmap) methodology, a repeatable digital transformation framework grounded in Christensen's innovation theory. Before founding his current firms, he spent nearly a decade at Boeing as a Program Manager leading M&A integration across billion-dollar business units, earning a Malcolm Baldrige National Quality Award and multiple Wichita Business Journal Innovator of the Year recognitions. He is the author of Stealing Clarity, a forthcoming book on data integrity and the behavioral science of organizational change.
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