Program Integrity

Compliance and the Reduction of Improper Payment, Fraud, Waste and Abuse

Better Care and Smarter Spending

Alliant ASO implements best practice recommendations to our clients for overpayment prevention and deploy provider education on proper billing practices to effectively reduce improper payments in the future, as part of our program integrity services. Alliant ASO provides efficient and consistent medical reviews and audits using our proprietary MedGuard® system, enabling us to quickly identify, recover, and prevent inappropriate payments for health care. MedGuard® functions include detecting, investigating, and preventing fraud, waste, and abuse by health plan participants. This system allows us to analyze claims and payment data using statistical and database techniques that look for patterns to suggest fraud and/or abuse.

MedGuard™ is the Alliant ASO system of integrated software applications and services that provides health plan integrity functions to identify, recover, and prevent inappropriate payments for health care. These functions include detecting, investigating, and preventing fraud, waste, and abuse by health plan participants. With MedGuard™, we are able to analyze claims and payment data using statistical and database techniques that look for patterns to suggest fraud or abuse. MedGuard doesn't rely solely on formulas to determine fraud, but uses a unique combination of software and experienced judgment from informed clinician/auditors. With Alliant ASO's MedGuard, you never have to wonder if an honest mistake is costing you money or if you have an integrity problem. We can, quickly and confidentially, provide you with the accurate information you need to make smart, operational decisions.

The Alliant Value:

  • Focus on large problems and patterns of potential problems, not just one incident
  • We can recommend best practices to avoid fraud and abuse
  • With MedGuard®, you never have to wonder if an honest mistake is costing you money or if you have an integrity problem
  • To prevent future overpayments, Alliant’s program integrity services include provider education on proper billing practices to effect a reduction of improper payments over time
  • Accurate, defensible findings ensure an improved recovery rate
  • Gain access to the information and data needed for program decision-making

Click the flyer below to learn more.