West Virginia Medicaid Fraud, Waste, and Abuse Services

Qlarant used its proprietary advanced data analytics tool to assist West Virginia’s Medicaid program in identifying and combating fraud, waste, and abuse related to the State Medicaid program by analyzing Medicaid claims data including medical, facility, pharmacy, and dental claims, detecting fraud, waste, and abuse, and inappropriate use of services. This contract included tasks such as data collection and validation, creating predictive models, implementing a data portal, developing action plans for mitigating fraud, waste, and abuse, and optimization of the predictive model and data visualization tool for prospective and retrospective identification of fraud, waste, and abuse.