Alert Quality and False Positive Rates
Monitor fraud alert precision, false positive reduction over time, and detection rule effectiveness by source and program.
Program Integrity Analytics
See the metrics that prove your program works.
AEGIS ISD Insights gives program integrity leaders real-time visibility into fraud detection effectiveness, investigation performance, recovery outcomes, and investigator productivity. Purpose-built dashboards for healthcare FWA programs — not generic BI tools.
Analytics across the investigation lifecycle
- Alert-to-case conversion rates and false positive tracking
- Investigation cycle time by queue, reviewer, and program
- Recovery amounts and corrective action completion rates
- CMS and state regulatory reporting support
Executive Dashboards
Real-time dashboards for program integrity leaders.
Program directors, SIU managers, and compliance officers need different views of investigation performance. AEGIS ISD provides role-appropriate dashboards that surface the metrics each leader cares about most.
Alert conversion rate
42%
Percentage of fraud alerts that progress to active SIU investigations.
Investigation cycle time
18 days
Average time from alert intake to final case determination across all programs.
Clinical review compliance
93%
Medical reviews completed with full documentation and clinical criteria met.
Annual recoveries
$8.6M
Total fraud and overpayment recoveries tracked by program and detection source.
Dashboard Categories
Analytics dashboards tailored to healthcare fraud investigation teams.
Each dashboard category addresses a specific program integrity concern — from alert quality to recovery performance.
Investigator Workload and Productivity
Track investigator and clinical reviewer capacity, case assignment balance, and individual performance metrics across queues.
Evidence Completeness Scoring
Measure documentation completeness at each investigation stage and identify cases at risk of insufficient evidence before determination.
Recovery and Overpayment Tracking
Follow overpayment identification, demand letter issuance, payment plan progress, and final recovery outcomes by program and provider type.
Program Impact and ROI
Measure fraud detection effectiveness, cost avoidance, and recovery ROI by line of business, detection source, and investigation team.
Compliance and Audit Reporting
Maintain audit-ready evidence documentation rates and generate regulatory reporting packages for CMS, state MFCU, and internal compliance reviews.
AI-Powered Analytics
Turn investigation data into guided decisions with AEGIS AI Assistant.
Ask follow-up questions against dashboard context to explain trends, identify root causes of performance changes, and receive recommended interventions. AEGIS AI Assistant understands your analytics context the same way it understands investigation context.
- Explain KPI movement by detection source and investigation workflow stage
- Identify top fraud outliers by provider billing patterns and case signals
- Recommend operational interventions to reduce investigation cycle times
- Summarize weekly or monthly program performance for leadership reporting
AEGIS AI Assistant
Dashboard Context
Question: Why did investigation cycle time increase in the last two weeks?
Cycle time trend analysis
- Evidence completeness dropped in two high-volume pharmacy fraud queues, causing review delays
- Medical review handoff timing increased by 1.8 days due to reviewer capacity constraints
- Recommendation: Rebalance queue assignments and implement document completeness gating before medical review handoff
Operational Intelligence
Identify investigation bottlenecks before they impact program outcomes.
Monitor workload distribution, evidence readiness, reviewer throughput, and queue health to keep healthcare fraud investigations moving efficiently.
Operational monitoring views
- Queue volume monitoring and backlog alerting
- Investigator workload balancing across programs and case types
- Evidence completeness scoring by investigation stage
- Reviewer throughput trends and SLA compliance tracking
Regulatory Reporting
Reporting built for CMS audits, state MFCU reviews, and leadership briefings.
AEGIS ISD reporting capabilities support the documentation and evidence requirements of federal and state healthcare fraud program oversight.
CMS and State Regulatory Reports
Generate audit-ready evidence summaries, corrective action tracking reports, and program outcome documentation aligned with CMS program integrity guidance and state MFCU reporting requirements.
- CMS-aligned program integrity outcome reports
- State MFCU referral documentation packages
- Corrective action tracking and compliance reporting
Strategic Program Analytics
Measure detection effectiveness, recovery performance, and program ROI with analytics designed for health plan leadership, board reporting, and regulatory submissions.
- Detection source effectiveness and alert quality trends
- Recovery performance by program, provider type, and investigation team
- Program impact and cost avoidance reporting by line of business
Key Metrics
Healthcare fraud detection metrics that matter.
AEGIS ISD tracks the investigation performance metrics that program integrity leaders need to justify budgets, demonstrate ROI, and satisfy regulatory requirements.
| Metric | Description | Typical Improvement |
|---|---|---|
| Alert Conversion Rate | Percentage of fraud alerts progressing to investigation | +15-25% |
| False Positive Rate | Alerts dismissed as non-actionable | -30-40% |
| Investigation Cycle Time | Days from alert to final determination | -25-35% |
| Evidence Completeness | Cases meeting documentation standards at determination | 90-95% |
| Recovery Rate | Identified overpayments successfully recovered | +15-20% |
| Investigator Productivity | Cases resolved per investigator per month | +20-30% |
FAQ
Common questions about AEGIS ISD program integrity analytics.
What analytics dashboards does AEGIS ISD provide?
AEGIS ISD provides dashboards for alert quality and conversion rates, investigation cycle times, investigator productivity, evidence completeness, recovery tracking, and regulatory compliance reporting. Dashboards are role-appropriate — program directors, SIU managers, and investigators each see the metrics relevant to their responsibilities.
Can AEGIS ISD generate reports for CMS or state regulators?
Yes. AEGIS ISD supports regulatory reporting for CMS program integrity requirements, state MFCU referral documentation, and internal compliance reviews. Reports include audit-ready evidence summaries, corrective action tracking, and program outcome documentation.
How does AI enhance the analytics experience?
AEGIS AI Assistant can answer follow-up questions against dashboard data, explain trends and KPI movements, identify root causes of performance changes, and recommend operational interventions. It understands the analytics context the same way it understands investigation context.
Can dashboards be customized by program or role?
Yes. Dashboards can be filtered and configured by program type (Medicaid, Medicare, commercial), investigation team, queue, time period, and user role. Program leaders and investigators see different default views appropriate to their responsibilities.
Next Steps
See the analytics dashboards your program integrity leaders need.
We will tailor analytics to your program goals, investigation KPIs, and regulatory reporting requirements.
Schedule an analytics walkthrough
- Define program integrity KPIs and reporting cadence
- Map fraud alerts to investigation outcomes and recoveries
- Configure role-appropriate dashboards for leaders and investigators