Prosecution intelligence for Medicare fraud investigators.
Vigil scores every Medicare provider in the country for fraud risk across six independent signals — then shows its work. Every lead carries full feature attribution, provenance back to CMS and OIG records, and a case package built to survive cross-examination.
Built on CMS Part B & Part D, OIG LEIE, and SAM.gov public records — every score traceable to source.
The fraud is documented. The evidence isn’t.
The government loses more than $100 billion a year to improper Medicare and Medicaid payments. Recovering it falls to the investigators who build the cases — Medicaid Fraud Control Units, state Attorneys General, and the qui tam bar — where the outcome turns almost entirely on the quality of the evidence.
The analytics that exist were built to deny claims and market to payers, not to support a prosecution. They surface risk with closed-box scores no expert can defend on cross-examination, or they catalog providers without ever saying which ones are worth investigating.
For the investigator building the case, that gap is the difference between a lead that stalls and a provider you can charge.
Score every provider. Investigate the worst. Document the case.
Score
Every Medicare provider in the country is scored across six independent signals — prior exclusions, billing anomalies, prescription patterns, referral structure, address clustering, and debarments — into one 0–100 composite.
Investigate
Drill into any provider with full SHAP feature attribution, the address cluster they sit inside, and their referral network — so you see not just the score, but exactly which facts produced it.
Document
Export a case package: a cover sheet, per-provider analysis, loss estimate, methodology appendix, and a complete audit log of every query — formatted to hand to DOJ or a grand jury.
Every lead leaves as a case package — not a dashboard.
One provider, one document, built to be read by people who will never log into the tool: a line prosecutor, a relator’s counsel, a reviewing judge. The numbers trace back to source CMS, OIG, and SAM.gov records, with download timestamps and a sealed audit log.
- PDF cover sheet plus per-provider analysis
- Methodology appendix included in every export
- Complete, timestamped audit log of every query
Validated the way a court would test it.
A model that scores high on the data it was trained on proves nothing. So Vigil is validated on a temporal holdout: trained only on OIG exclusions recorded before 2023, then measured against exclusions that landed in 2023 and later — providers the model had never seen.
On that test, the composite ranking recalls 15.2% of genuinely excluded providers in its highest-risk tier — a forward-looking measure, not a number tuned in hindsight.
The full methodology document — feature definitions, weighting, and validation — is included in every case package, so the analysis is defensible on its face.
Built for the people who bring the case.
MFCU investigators
Medicaid Fraud Control Units inside state Attorneys General offices. Vigil ranks every provider and shows the analysis behind each lead, so investigative hours go to the cases most worth pursuing — not to assembling the data.
State Attorneys General
Offices deciding which providers to charge. Vigil delivers a clear loss estimate, a documented basis for every score, and a sealed audit trail that holds up under scrutiny.
False Claims Act attorneys
Plaintiffs’-side qui tam counsel building healthcare whistleblower cases. Vigil turns a relator’s tip into a defensible, evidence-backed complaint — the kind DOJ is far more likely to intervene on.
See how the worst providers in the country score.
Walk the demo, or get in touch about access for your firm or unit. Engagements are scoped individually.