The Program Integrity Crisis
Medicare and Medicaid improper payments total over $60 billion annually, while quality outcomes have flatlined. Current oversight approaches aren't working.
CMS CERT reports show persistent 6-7% error rates year after year, totaling roughly $31 billion annually.
PERM data shows Medicaid improper payment rates as high as 21% in recent years, representing tens of billions in waste.
Readmission rates, hospital-acquired infection rates, and CMS penalty rates have barely moved since 2020 despite billions in consulting spend.
Continuous Intelligence for Program Integrity
From claims intelligence to network oversight, Guardian agents autonomously monitor, detect, investigate, and route — so your team focuses on decisions, not data wrangling.
Claims Intelligence & Payment Integrity
Autonomous detection and investigation of billing anomalies, payment integrity risks, and claims outliers across Medicare and Medicaid programs.
Encounter Completeness & Data Quality
Continuously evaluate encounter data completeness, flag data-quality gaps across MCOs, and surface corrective insights for your Medicaid or Medicare program.
MCO & Plan Performance Monitoring
Continuous monitoring of managed care organization performance metrics, utilization patterns, and program compliance across your entire network.
Network Oversight & Provider Profiling
Comprehensive provider network intelligence — from utilization patterns to provider benchmarking and network integrity evaluation.
Program Integrity & Audit Readiness
Maintain audit readiness and proactively detect program integrity risks before they become federal findings.
Claims Intelligence & Payment Integrity
Autonomous detection and investigation of billing anomalies, payment integrity risks, and claims outliers across Medicare and Medicaid programs.
See Guardian in Action
Explore real investigations with full evidence chains, streaming analysis, and interactive chat — powered by autonomous agents.
Sentry: FWA Investigations
ChartR SentryRecent Runs
5Data Sources
Provider Upcoding Ring
Medicare FFS · E&M Level 5 Billing Anomaly
Investigation Summary
ChartR Sentry Analyst
Ask me about this investigation:
Guardian: Statewide Oversight
ChartRRecent Runs
5State Data Sources
Encounter Completeness & Timeliness
Statewide Medicaid · Q4 2025 Encounter Review
Investigation Summary
ChartR Oversight Analyst
Ask me about this investigation:
Who Uses Guardian
State Medicaid Directors
Real-time visibility into program integrity risks, encounter completeness, and MCO performance across your entire Medicaid program.
Program Integrity Officers
Autonomous payment integrity detection and investigation workflows that surface the signal from millions of claims.
MCO Compliance Teams
Continuous monitoring of encounter submissions, quality metrics, and regulatory requirements.
CMS Regional Offices
Cross-program performance analytics and trend detection across Medicare and Medicaid populations.