About AEGIS ISD
We exist to make healthcare program integrity faster, fairer, and more defensible.
AEGIS ISD, LLC is a healthcare program integrity company that builds technology for fraud detection, SIU case management, medical review, and recovery tracking. We help health plans and state agencies protect programs from fraud, waste, and abuse while supporting fair, transparent provider relationships.
Our mission
Deliver clear, defensible outcomes for healthcare program integrity teams through a unified platform that combines fraud detection, case management, medical review, recovery tracking, and AI-powered investigation tools in one configurable, audit-ready workspace.
Our Story
Built by people who know program integrity from the inside.
AEGIS ISD was founded by healthcare program integrity professionals who spent years working with the disconnected tools, manual processes, and fragmented workflows that most SIU and compliance teams still rely on today.
We saw investigators toggling between five different systems to manage a single case. We saw medical reviewers emailing clinical attachments because the case management system could not store documents. We saw program directors building performance reports in spreadsheets because their platforms lacked analytics. We built AEGIS ISD to solve these problems — a single, unified platform where fraud detection, case management, medical review, recovery tracking, and analytics all share one case record.
Unlike legacy FWA platform vendors that have grown through acquisition and stitched together incompatible modules, AEGIS ISD was designed from day one as a unified system. Every feature shares the same data model, the same permissions framework, and the same audit trail.
The problem we solve
- Investigators waste time switching between disconnected tools
- Medical reviewers lack structured clinical documentation workflows
- Program leaders cannot see investigation performance in real time
- Legacy platforms require vendor professional services for every workflow change
- AI is bolted on as a separate layer, not embedded in investigation workflows
Leadership
Meet the Leadership
Our team combines healthcare program integrity domain expertise, clinical review experience, technology leadership, and operational execution to deliver evidence-first fraud investigation outcomes for health plans and state agencies.
CEO
Executive Leadership
Drives company strategy, health plan partnerships, and program integrity outcome delivery. Brings deep experience in healthcare fraud detection operations and payer relationships.
Clinical
Medical Review Leadership
Leads clinical governance, medical necessity review standards, peer reviewer workflows, and documentation quality programs. Ensures clinical determinations are defensible and evidence-based.
Compliance
Program Integrity Leadership
Guides fraud detection strategy, surveillance program design, regulatory compliance, and audit readiness across Medicaid, Medicare, and commercial programs.
Our Values
Principles that guide how we build and deliver.
Evidence-First Decisions
Every investigation decision in AEGIS ISD is tied to structured evidence, documented clinical criteria, and auditable case history. We believe defensible outcomes start with evidence, not assumptions.
Operational Transparency
Program integrity teams deserve clear visibility into investigation performance, team workload, and program outcomes. AEGIS ISD provides real-time analytics because leadership decisions should not depend on spreadsheet reports.
Security Without Compromise
Healthcare fraud investigation involves protected health information, legal determinations, and regulatory obligations. AEGIS ISD embeds role-based access control, tenant-isolated data, and immutable audit logging into every feature by design — not as an afterthought.
Who We Serve
Healthcare organizations that investigate fraud, waste, and abuse.
AEGIS ISD serves the teams responsible for protecting healthcare program dollars across Medicaid, Medicare, and commercial health plans.
Medicaid Managed Care Plans
Program integrity and SIU teams at Medicaid managed care organizations investigating provider fraud, member eligibility issues, and medical necessity concerns.
Medicare Advantage Plans
SIU and compliance teams at Medicare Advantage plans managing fraud alerts, provider investigations, and CMS program integrity requirements.
Commercial Health Insurers
Fraud investigation and medical review teams at commercial health plans addressing provider billing fraud, pharmacy fraud, and behavioral health concerns.
State Medicaid Agencies
State program integrity divisions and Medicaid Fraud Control Units managing statewide fraud detection, provider surveillance, and recovery programs.
Special Investigations Units
SIU investigators and supervisors who manage healthcare fraud cases from initial alert through investigation, determination, and recovery.
Medical Review Teams
Clinical reviewers and medical directors who conduct medical necessity reviews, peer consultations, and clinical documentation assessments.
Program Impact
Measurable outcomes for healthcare program integrity teams.
Improvement in claim accuracy with pre-pay fraud detection validation.
Faster case resolution from alert intake to final determination.
Cases meeting full evidence and documentation standards at determination.
Increased fraud recovery amounts through earlier detection and structured tracking.
Why AEGIS ISD
Why healthcare organizations switch from legacy FWA platforms.
Organizations choose AEGIS ISD when they have outgrown the limitations of legacy fraud detection platforms or need to replace disconnected point solutions with a unified investigation workspace.
Four reasons teams switch
- Unified workspace — Replace five disconnected tools with one platform where detection, case management, medical review, recovery, and analytics share a single case record
- Embedded AI — AEGIS AI Assistant is built into every investigation screen with a 5-level graduated trust model, not bolted on as a separate analytics layer
- No-code configuration — Business users configure workflows, risk rules, queues, and approval paths without vendor professional services or custom development
- Tenant-isolated security — Schema-per-tenant database architecture provides stronger data isolation than shared-schema platforms used by most legacy vendors
Connect
Ready to modernize your healthcare fraud detection program?
We will align your team on investigation workflows, data integration, and measurable program integrity outcomes.
Get started
- Review your current fraud detection and investigation operations
- Identify quick-win workflow improvements and integration priorities
- Plan a phased rollout with measurable success criteria