Program integrity intelligence across every agency, every dollar, every program — from Medicaid to SNAP, child welfare to workforce services
Real-time monitoring across 50+ fraud vectors and 8 program integrity lifecycle stages
Fraudulent credentials, false affiliations, excluded provider re-enrollment, shell entities
Ineligible individuals, income misrepresentation, duplicate enrollment across programs, identity fraud
Unauthorized services, level-of-care manipulation, prior auth bypass, unnecessary referrals
Upcoding, unbundling, phantom billing, duplicate claims, misrepresented services
Fee schedule violations, incorrect rate application, missed edits, policy override abuse
Duplicate payments, overpayments, payment to ineligible entities, vendor kickback patterns
Pattern detection, recovery identification, network analysis, outlier flagging
Audit trail documentation, regulation mapping, cross-program compliance, federal reporting
Upcoding, unbundling, duplicate billing, phantom services, misrepresented place of service, date of service manipulation
Credential fraud, excluded entity enrollment, identity theft, kickbacks, self-referral violations, shell company networks
Eligibility misrepresentation, identity fraud, duplicate enrollment across programs, out-of-state coverage
Capitation overpayment, encounter data manipulation, cost avoidance, subcontractor misuse, access standard violations
Multi-program double-dipping, data mismatch between agencies, benefit stacking abuse, coordinated fraud rings
Authorization bypass, claims system abuse, data integrity violations, reporting manipulation
Machine learning models identify statistical anomalies in claims, provider behavior, and beneficiary utilization across Medicaid, SNAP, TANF, child welfare, workforce, and housing programs. Models are trained on known fraud cases and updated weekly as new patterns emerge.
We correlate data across ALL state-funded programs. A provider defrauding Medicaid is also checked against SNAP vendor data, child welfare placements, and workforce training payments. Fraud rings don't operate in one program — neither does Sentinel.
Claims are analyzed in real-time as they arrive. Fraud is detected before payment is processed. Prevention beats recovery. We stop $1 of fraud before it costs states $5+ in recovery effort.
Identify underpayments, denials, and optimization opportunities across all programs
Sentinel identifies recovery opportunities and prioritizes them by revenue impact and actionability. HRN Group (our sister division) can handle execution—appeals, provider outreach, claims resubmission. Or states can action findings in-house with full documentation.
Typical ROI: $5-$8 recovered for every $1 spent on Sentinel oversight.
Real-time program integrity visibility across every funded program
Deep-domain monitoring capabilities tailored to each program area
MCO compliance monitoring, prior authorization denial tracking, observation vs. inpatient downgrades, network adequacy, encounter data completeness. Hospital claims = 6-7% of volume but 62-70% of denied dollars.
Placement payment verification, provider licensing compliance, caseworker caseload analysis, congregate care rate audits, independent living program outcomes, Title IV-E claiming accuracy.
Retailer fraud detection, EBT trafficking patterns, eligibility verification against employment data, duplicate participation across states, vendor compliance monitoring.
Claimant eligibility verification, employer fraud detection, training program outcome tracking, cross-state claims matching, identity verification for UI benefits.
Service verification against treatment plans, provider credential monitoring, outcomes-based compliance, duplicate billing across behavioral health and Medicaid, opioid treatment program oversight.
Tenant eligibility verification, landlord payment accuracy, supportive housing outcomes tracking, coordinated entry data integrity, HUD compliance monitoring.
Every program has unique fraud signatures, compliance requirements, and payment structures. A one-size-fits-all approach misses program-specific patterns that cost states billions. Sentinel deploys domain-specific detection models for each program area, with capabilities already proven in active state deployments.
Sentinel's agency-specific oversight capabilities are deployed today as part of active state grant programs, with measurable results: millions in recoverable revenue identified within the first year of operation.
Integrated 3-layer system from data to intelligence
Ingest claims, eligibility, enrollment, authorization, case management, and payment data from ANY state program in any format — 837 transactions, HL7, CSV, EDI, state proprietary formats, case management exports. Standardize to common data model. Secure SFTP upload with AES-256 encryption. No system integrations or ETL middleware required.
50+ vector fraud matrix applied across 8 lifecycle stages with cross-program patterns. Machine learning models trained on known fraud cases, regulatory violations, and patterns across all program types. Real-time processing as claims arrive. Risk scoring and prioritization by impact. Weekly model updates as new fraud patterns emerge.
Executive dashboards for legislators and agency leadership. Audit-ready documentation for every finding. Quarterly legislative reporting with MDRS compliance. Proviso tracking and budget monitoring. All outputs formatted for federal oversight, state audits, and public reporting across all program areas.
We process and correlate data from the most authoritative sources
Medicare/Medicaid fraud databases, OIG exclusion lists, NPPES provider data, fee schedule corrections
Claims, eligibility, enrollment, authorization, and case management data across Medicaid, SNAP, TANF, child welfare, and workforce programs
Encounter data, capitation payments, subcontractor records, provider credentials, managed care fee schedules
SNAP retailer databases, EBT transaction patterns, FNS compliance data, retailer authorization records
UI claims data, employer records, wage verification, training program enrollment, cross-state employment records
State program policies, CMS waiver terms, federal guidelines, managed care contracts, administrative rules
IRS 990 nonprofit filings, CMS Open Payments, OIG reports, state legislative records, SAM.gov exclusions, FPDS contracts
835 ERA files, claim-to-payment reconciliation, denial reason codes, payment adjustments, EFT confirmations
State and federal agencies nationwide are deploying Sentinel to detect fraud, recover revenue, hold contractors accountable, and meet oversight requirements across every funded program. Schedule a demo to see how we can serve your agency.
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