Fraud, Waste & Abuse that Safeguards Care and Compliance
With clinical insight and compassionate oversight, our solutions prevent fraud, reduce improper payments, and protect the people behind every program.
Fraud, Waste, &
Abuse Prevention
When healthcare systems are overwhelmed, every dollar and decision counts. By combining trained AI technology and clinical expertise, we efficiently review claims and related data to identify potential issues, protecting resources and reinforcing trust in the systems built to serve people.
We have helped agencies reduce exposure and recapture lost resources through:
- Recovering $165M+ in improper payments for CMS over three years
- Returning $4.60 in program savings for every dollar spent
- Monitoring data across 10 million providers and 27 states to flag early risk patterns
Payment Accuracy & Error Rate Reduction
When billing errors go unchecked, patients and programs pay the price. We combine real-time tracking with expert reviews to reduce errors and recover funding—helping agencies uphold accountability and deliver on their care missions.
We improve reimbursement accuracy and financial integrity by applying deep clinical and coverage expertise across both fee-for-service and capitated healthcare plans.
- Completing over 600,000 clinical and medical reviews per year
- Verifying billing codes accurately reflect clinical intent
Claims & Medical
Review Audits
With every claim reviewed, lives and livelihoods are on the line. Clinician-reviewed audits ensure fairness and precision in every claim—strengthening healthcare compliance and protecting patients with timely, accurate decisions.
We drive confident decisions and audit readiness with:
- 500+ clinical experts spanning all Medicare specialty areas
- Embedded review processes aligned to policy and coverage guidelines
- Support for both pre- and post-pay audits with evidence-backed analysis
AI-Enabled Outlier Monitoring &
Risk Insights
Commence brings clarity to complexity—turning high-volume health data into high-value insights. Our AI-powered platform accelerates detection, cuts down on errors, and helps healthcare leaders act swiftly and confidently in a fast-changing environment.
We make risk detection faster and more effective by:
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Delivering scalable oversight tools that surface outliers and flag potential patient safety or quality issues
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Enabling earlier interventions that prevent fraud, reduce waste, and protect healthcare integrity
The Future of Fraud, Waste & Abuse Protection Starts Here
Partner with Commence to reduce risk, recover resources, and deliver compliance with confidence. Let’s talk about building a smarter path forward.
Veteran Healthcare That Delivers Faster
Commence redefined record retrieval for the Veterans Benefits Administration—digitizing 820M+ records, cutting turnaround time by 70%, and saving $40M+ in processing costs. Our human-centered, data-powered approach accelerated access to benefits and care for veterans across the country.
Stats
825M+
$40M+
16,000+
Scaling TRICARE with Speed & Precision
With 750K+ transactions processed monthly and a 300% productivity lift, Commence helped transform TRICARE’s $65B claims operation into a faster, more resilient system. Driven by clinical oversight and automation, we delivered scalable solutions aligned with DHA’s mission to improve medical readiness and patient experience.
Stats
300%
16,000+
750K+
Detecting Fraud Earlier, with Greater Accuracy
Commence increased fraud detection by 45% and reduced false positives by 30% through AI-driven alerts and clinical review integration.
Stats
45%
30%
Oversight across
