Fraud, Waste & Abuse (FWA)

The Universal Program Integrity Solution for Healthcare

The only solution that offers a unified product suite providing Fraud, Waste, & Abuse Prevention and Program Integrity essentials for the right program integrity culture and practice: the All-Data Platform, Tailored Data Analytics, and Integrated Case Management.

Empowers end-to-end program integrity and fraud, waste, and abuse prevention, including targeted analytics and predictive insight for high-risk areas, provider revalidation, prepay analytics, post-pay analytics, HCBS program integrity, home health aid and personal care assistant (PCAs) program integrity, HomeCare Analytics,™ and waste, inefficiencies, and duplication prevention.

Medicaid Program Integrity

For Medicaid Program Integrity, Surveillance Utilization Review, Healthcare Crime Units, and Medicaid Fraud Control Units, Torch offers powerful data analytics that automatically finds suspicious providers and alerts you to fraud schemes.

Healthcare Fraud, Waste & Abuse

From impossible days to inpatient overlap to incorrect billing, Torch empowers users with a library of reports and ad-hoc analysis to explore conflicts and billing behaviors to improve economic efficiencies with prepayment and post-payment review.

Investigations

Investigations are the heart of Torch, with comprehensive tools designed for users of any technical skill level. There's no need to write queries. Complex questions can be answered in minutes, pointing users directly to evidence.

Case Management Workflow

Torch's configurable case management component is integrated directly with the data analytics component. With true bi-directional automation, information in analytics is populated in case management and vice-versa, dramatically improving workflow efficiences.

Health Insurance Fraud

Torch enables private health insurers to uncover instances of fraud, including suspicious providers and recipients. With a library of tools, Torch can be used to uncover any type of fraud scheme.

Dental Fraud

Explore dental claims, inpatient overlap, suspicious billing and more, from procedures to individual tooth-level analysis. Generate instant reports with a few clicks or send dental offices notices.

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