Fraud is Never Okay. Waste and Abuse is something that shouldn’t happen.

Aegis partners with state and federal programs to strengthen payment integrity, reduce fraud, waste, abuse and ensure accurate reimbursement across complex provider networks. We bring evidence-first audits, CMS-aligned policy expertise, and operational playbooks that speed clean payments while stopping what shouldn’t be paid.

Target high-yield risk with analytics-led FWA audits built to withstand scrutiny. We surface coordinated behavior, time/volume anomalies, ghost billing, and documentation gaps—and translate findings into recoveries, sanctions, and network hygiene.

What You Can Expect:

  • Pattern analytics: upcoding/unbundling, duplicate claims, referral/ownership loops
  • High-risk service cohorts (DME, lab/genetics, infusion, pain, telehealth, BH/therapy)
  • Documentation & coding sample review mapped to LCD/NCD and plan policy
  • Provider/network integrity: licensure, credentialing, supervision/scope compliance
  • Case building for recoveries, sanctions, and referrals to law enforcement/OIG
  • Training & provider education to reduce recurrence

What you Can Expect from Us:

  • Case files with citations, exemplars, timelines, and overpayment estimates
  • Enforcement/administrative action recommendations and escalation playbooks
  • FWA dashboards (hit rates, recoveries, cycle time, recurrence)
  • Measurable recoveries, fewer false positives, lower member/provider abrasion
  • Cleaner networks and stronger public-trust signals

Get a personal consultation.

Let’s chat about how we can work together.

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