Core
SIU case management, investigation workflows, and audit-ready case records for healthcare fraud investigations.
Learn moreHealthcare Program Integrity Suite
Detect fraud. Investigate faster. Recover more.
AEGIS ISD is a unified healthcare program integrity platform that combines pre-pay claims intelligence, SIU case management, medical review, and recovery tracking in one audit-ready workspace. Built for Medicaid, Medicare, and commercial health plans.
Product Suite
Five products. One unified platform.
Detect
Pre-pay claims intelligence, fraud scoring, and automated routing to prioritize high-value alerts.
Learn moreDataBridge
Data integration and normalization engine that connects claims, provider, member, and external intelligence.
Learn moreAI
Context-aware AI assistant built into every screen with evidence-linked summaries and recommended next actions.
Learn moreDrive
Secure document management and evidence store with version control and immutable audit trails.
Learn moreHow It Works
From suspicious signal to defensible outcome in four steps.
AEGIS ISD connects every phase of the healthcare fraud investigation lifecycle. Unlike legacy platforms that require manual handoffs between detection, investigation, and recovery, our unified workflow moves cases from signal to outcome with evidence captured at every step.
Step 01
Ingest
Normalize claims, provider, member, and external intelligence data into a unified case record.
Step 02
Score
Apply configurable rules, risk models, and fraud indicators to prioritize high-value alerts.
Step 03
Investigate
Manage evidence collection, clinical collaboration, peer review, and case determinations.
Step 04
Resolve
Capture outcomes, overpayment recoveries, corrective actions, and regulatory referrals.
Core Workflows
A healthcare fraud detection platform built for program integrity teams.
AEGIS ISD is a healthcare fraud detection and case management platform designed for Special Investigations Units (SIUs), program integrity departments, and medical review teams. Unlike legacy FWA platforms that require separate modules for detection, investigation, and recovery, AEGIS ISD unifies the entire fraud, waste, and abuse lifecycle in one configurable workspace.
SIU Case Management
Centralize evidence, communications, and determinations in one audit-ready case record for healthcare fraud investigations.
Fraud Detection & Triage
Prioritize fraud alerts with configurable rules, risk scoring, and automated routing to the right investigator or queue.
Medical Review
Coordinate clinical peer reviews, medical necessity determinations, and documentation workflows with structured evidence.
Provider Surveillance
Monitor billing patterns, utilization outliers, and high-risk provider networks with continuous surveillance dashboards.
Recovery Tracking
Track overpayments, recovery actions, and corrective measures from identification through resolution.
SVRS Sampling
Statistically Valid Random Sampling for healthcare claim audits: RAT-STATS-aligned methodology, Cochran's-formula sample sizing, Fisher-Yates random selection, Mean Per Unit extrapolation. Methodology PDF v2.0 attached to every sample run.
Who We Serve
Built for the teams that protect healthcare programs.
AEGIS ISD serves program integrity teams across Medicaid, Medicare, and commercial health plans who investigate fraud, waste, and abuse.
Medicaid Managed Care Plans
Medicare Advantage Plans
Commercial Health Insurers
State Medicaid Agencies
Special Investigations Units
Program Integrity Departments
AI & Security
Ask questions in context. Get answers you can act on.
AEGIS AI Assistant is a context-aware AI built into every screen of the AEGIS ISD platform. While viewing a case, lead, document, or provider profile, investigators can ask natural-language questions and receive evidence-linked summaries, similar case matches, and recommended next actions. It is not a generic chatbot — it understands your active investigation context.
AEGIS AI Assistant
Question: What should we prioritize before closing this investigation?
Recommended actions
Request missing clinical attachment from provider before determination. Run similarity analysis against 3 recently resolved provider fraud cases. Route to medical review queue — risk score exceeds clinical review threshold.
Evidence linked from 4 case documents, 2 provider records
SOC 2
Service organization controls for security, availability, and confidentiality.
HIPAA
HIPAA-aligned safeguards for protected health information.
RBAC
Segment permissions by program, investigation type, and queue.
Tenant Isolation
Each organization's data is isolated in a dedicated database schema. No shared tables, no commingled PHI.
Immutable Audit
Every action, decision, evidence attachment, and communication is captured in an immutable, timestamped case timeline ready for regulatory review.
FAQ
Common questions about AEGIS ISD.
What is AEGIS ISD?
AEGIS ISD is a healthcare program integrity platform that unifies fraud detection, SIU case management, medical review, and recovery tracking in one workspace. It is designed for Medicaid, Medicare, and commercial health plan program integrity teams who investigate fraud, waste, and abuse.
Who uses AEGIS ISD?
AEGIS ISD is used by Special Investigations Units (SIUs), program integrity departments, medical review teams, and compliance officers at health plans and state Medicaid agencies.
How is AEGIS ISD different from legacy FWA platforms?
Unlike legacy platforms from vendors like Cotiviti, Optum, or SAS that require separate modules for detection, case management, and analytics, AEGIS ISD provides a unified workspace where all investigation activities happen in one place. It also includes a 5-level graduated AI trust model, schema-per-tenant data isolation, and no-code workflow configuration.
How does AEGIS ISD support pre-pay fraud detection?
AEGIS ISD brings intelligence and detection upstream into the pre-pay claims process. By validating eligibility, authorization, and medical necessity before payment, it reduces improper payments, claim denials, and the need for costly post-pay recovery.
Can workflows be configured for different programs?
Yes. Queues, SLAs, review stages, evidence requirements, risk scoring rules, and approval paths are fully configurable by line of business — Medicaid, Medicare, or commercial — without custom code.
How does AEGIS ISD support audit readiness?
Every case decision, evidence attachment, communication, and status change is captured in an immutable timeline. Cases can be exported with full audit trails for CMS, state MFCU, or internal compliance review.
Get Started
Ready to modernize your healthcare fraud detection?
Schedule a demo tailored to your program integrity workflows, data sources, and investigation requirements.