MARQUEANALYTICSMEDICAID PROVIDER-NETWORK INVESTIGATIONS
A shut-down billing entity often re-enrolls under a new name: same suite, same officers, same billing agent. Claim edits and NPI screens see a new provider. Marque links owners, addresses, phones, billing agents, exclusion lists and federal loan records to trace the new name to the old one.
Same suite, same officer
An entity is excluded or closes. Months later a new enrollee appears at the same suite, through the same billing agent, with an officer from the old one. Claim edits see a new provider. Marque links the two, and each link leads back to its source record.
A new enrollee names the same officer and suite as an entity excluded earlier. The exclusion record carried no NPI to match, so the link runs through the officer’s name and the suite.
Illustrative composite. No real provider depicted.
PAYMENT INTEGRITY
Every entity is scored on ten signals. In the Program Integrity Engagement, the top of the register goes to investigators for field and open-source verification before anything is called a finding.
Discuss the Exposure AssessmentLITIGATION SUPPORT
Every mandate is checked for conflicts. Data from payer and agency engagements never enters a matter for counsel.
Discuss litigation supportOne unusual number has many innocent explanations. Several independent signals on one entity have fewer.
Claims, provider registries, exclusion lists, corporate filings, federal loan records and physical addresses, joined on a single entity and read as one file.
OUTPUTSource records joined on a single entity.
Priorities with the reasons behind them.
Relationships, sources, and a documented timeline.
A 60-minute working session with leadership and investigators.
The 10 business days begin when the agreed extract is received and passes validation. Fees quoted on mandate.
Every entity re-scored monthly, each new enrollee screened, alerts when entities gather around the same suite, phone, owner or agent.
Discuss Network WatchWhere the findings call for more, the Program Integrity Engagement goes deeper, with field and open-source verification.
Explore the engagementEvery mandate is led by a principal named in the statement of work.
Founder & Chief Executive Officer
U.S. Naval Academy. Navy officer. Deloitte M&A.
Chief Technology Officer
U.S. Naval Academy. Navy SOF/EOD veteran. Machine learning, infrastructure and security.
Chief Data Officer
Yale mathematics. 14 years of Medicaid actuarial analysis, including managed care.
OSINT Director
Army infantry veteran. Open-source investigation, case management and legal operations.
U.S.-based team. Client data, and anything derived from it, is used only for that client’s engagement. Data is returned or destroyed at close.
If your SIU does not open a review on at least one entity in the Top-25 register, the fee is returned.
Applies to payer Exposure Assessments. For state agencies, terms are set in writing.
Conflicts check, mutual NDA, business associate agreement, then written scoping.