ACS' fraud and abuse protection solutions are designed to provide states with more detailed, individualized, narrowly-focused fraud and abuse studies. We offer a Web-based fraud detection suite that identifies dubious medical claims and healthcare fraud, billing errors, overpayments, waste, abuse, and non-compliance, which has been proven to generate significant savings for our clients. Our fraud and abuse detection capabilities include advanced claims auditing to ensure that claims are billed correctly and that potentially fraudulent or inappropriately billed claims are identified prior to payment.

The ACS fraud and abuse offerings incorporate tools to analyze provider and member data to ensure that they meet program requirements for participation in the supported healthcare programs. Eliminating recipients and providers from the programs that may not meet qualifications, have criminal records, or other issues, ensures that program funds are directed to meet the needs of the valid participants the programs are designed to serve. Findings from these analyses facilitate the collection of inappropriate, previously billed claims, as well as the elimination of future inappropriate billings.