FWA Investigation Platform
The AEGIS ISD platform provides healthcare fraud investigation teams with a configurable workflow engine, structured evidence management, claims data integration, role-based security, real-time analytics, and embedded AI assistance — all in a multi-tenant cloud architecture built for HIPAA compliance.
Core Platform Modules
Six integrated modules that share a unified data model, role-based permissions, and audit-ready logging.
Design investigation workflows with configurable queues, stage deadlines, escalation paths, approval gates, and automated routing rules. Adapt workflows to Medicaid, Medicare, or commercial program requirements without code changes.
Capture claims records, clinical documents, communications, and investigation notes in structured, searchable case timelines. Every evidence attachment is version-controlled and linked to specific case actions.
Support medical necessity reviews with structured documentation checklists, peer reviewer assignments, clinical criteria references, and threaded reviewer discussions. Connect clinical findings directly to investigation outcomes.
Monitor alert conversion rates, investigation cycle times, recovery outcomes, and investigator productivity with live dashboards. Drill down by program, queue, reviewer, and time period.
Connect claims feeds (837/835), provider credentialing databases, member eligibility systems, OIG exclusion lists, SAM databases, and state Medicaid data warehouses through standard APIs and batch import processes.
Apply role-based access control, data retention policies, and immutable audit logging to every platform action. Support HIPAA Security Rule requirements, CMS program integrity guidance, and state regulatory expectations.
Architecture
AEGIS ISD's platform architecture addresses the unique requirements of healthcare fraud investigation — multi-tenant data isolation, real-time collaboration, standards-based integration, and cloud-native deployment.
Every organization operates in its own database schema. No shared tables, no cross-tenant queries, no commingled protected health information. This schema-per-tenant architecture exceeds the data isolation requirements of most healthcare compliance frameworks.
Server-sent events (SSE) deliver live case updates, assignment notifications, and workflow state changes to investigators without page refresh. Teams see case activity as it happens, reducing communication delays.
Every platform capability is accessible through RESTful APIs. Connect claims adjudication systems, provider directories, member eligibility databases, and external intelligence sources through documented, versioned endpoints.
Containerized services deployed on Kubernetes with automated scaling, rolling updates, and infrastructure-as-code provisioning. Designed for high availability and disaster recovery in regulated healthcare environments.
Investigation Lifecycle
The AEGIS ISD platform connects every phase of the healthcare fraud investigation lifecycle, ensuring evidence continuity and audit readiness from initial alert through final resolution.
Normalize claims, provider credentialing, member eligibility, and external intelligence data (OIG exclusion lists, SAM, state databases) into a unified investigation record.
Apply configurable fraud detection rules, risk scoring models, and statistical thresholds to prioritize alerts. Route high-priority signals to the appropriate investigation queue automatically.
Manage evidence collection, clinical peer review, provider outreach, and case determinations in a structured workflow. Every action is logged in an immutable case timeline.
Capture outcomes, overpayment calculations, recovery actions, corrective measures, and regulatory referrals. Export audit-ready case packages for CMS, state MFCU, or internal compliance review.
Investigation Workspace
The AEGIS ISD investigation workspace gives fraud analysts, SIU investigators, and medical reviewers a single operational view of all active cases, evidence, and investigation activity.
Correlate claims, provider, and member signals to identify fraud patterns. Explainable risk scoring shows investigators exactly which indicators triggered an alert and why.
Surface fraud trends, provider outliers, and risk clusters with role-appropriate dashboards for investigators, supervisors, and program leaders.
Design investigation workflows that match your program policies, clinical standards, and SIU procedures without code changes or vendor professional services.
Analyze millions of claims records without sacrificing query speed or investigation responsiveness. Built for the data volumes of large Medicaid and Medicare programs.
Capture every investigation decision, document attachment, communication, and status change in a tamper-proof, chronological case timeline.
Data & Integrations
AEGIS ISD integrates with the claims, provider, member, and external intelligence data sources that healthcare fraud investigation teams depend on. Reduce manual data entry and ensure investigators have complete, current information.
AI-Powered Investigation
AEGIS AI Assistant reads the active case, lead, document, or provider context from the investigator's current screen and provides evidence-linked answers, similarity matches, and recommended next actions. It is not a separate analytics tool — it is built into the investigation workflow.
Question: Find providers with similar billing patterns and highlight fraud risk indicators.
Platform Performance
Improvement in fraud alert accuracy with configurable risk scoring and triage rules.
Reduction in average time from alert to determination with automated workflows.
Cases meeting full documentation standards at the time of final determination.
Increased fraud recovery amounts through earlier detection and structured tracking.
FAQ
AEGIS ISD is built with Java 21 and Spring Boot on the backend, Angular on the frontend, and PostgreSQL for the database. It runs as containerized services on Kubernetes and supports deployment in cloud and on-premise environments.
Each organization operates in its own dedicated database schema. There are no shared tables or cross-tenant queries. This schema-per-tenant architecture ensures complete data isolation and exceeds HIPAA data segregation requirements.
AEGIS ISD integrates with standard 837 and 835 transaction formats, custom claims feeds, provider credentialing databases, member eligibility systems, OIG exclusion lists, and SAM databases through RESTful APIs and configurable batch import processes.
AEGIS ISD is designed to support HIPAA Security Rule compliance with role-based access control, encryption at rest and in transit, immutable audit logging, and schema-per-tenant data isolation. The platform supports the administrative, physical, and technical safeguards required by HIPAA.
Most organizations launch their first program within 90 days following a phased approach: workflow discovery and data integration (weeks 1-4), configuration and testing (weeks 5-8), and user training and go-live (weeks 9-12). Additional programs are added in subsequent phases.
Implementation
Start with fraud detection and triage, then expand into medical review, recovery tracking, and advanced analytics.
