Verify FWA™
Fraud, Waste & Abuse and Program Integrity Support
Verify: FWA™ surfaces irregularities for trained staff to review, organizes casework, and keeps a complete audit trail, supporting accurate, well-stewarded programs without replacing human judgment, and without replacing your existing system.
~90 days
Deploys onto your existing IES
AI-assisted
Pattern & anomaly analysis
Human review
Built into every case
ARC-AMPE
SOC 2 · NIST 800-53 aligned
What is Program Integrity Support?
Program-integrity support helps states protect the accuracy and integrity of Medicaid programs, surfacing potential errors and irregularities (often categorized as fraud, waste, and abuse, or FWA) so trained staff can review and resolve them responsibly.
Verify: FWA™ is a tool that supports program-integrity teams: it informs decisions, it doesn't make them.
Capabilities
What the Module Does
Built to help integrity teams work accurately, consistently, and with a clear record.
Pattern & Anomaly Analysis
AI-assisted analysis surfaces irregularities across program data for staff to review: flagging, not deciding.
Case Management
Organize, prioritize, and document reviews end to end, so nothing falls through the cracks.
Audit-Ready Records
Complete audit trails support fair, consistent, and defensible decisions.
Configurable to Your Program
Rules and thresholds tuned to your policies, with human review built into the workflow.
How Review Works
A workflow with people at the center, layered onto the systems you already run.
Surface
AI-assisted analysis flags potential irregularities across program data for review.
Review
Trained staff examine flagged cases with full context: the human-in-the-loop step.
Resolve
Outcomes and resolutions are
documented, with a complete audit trail.
Our Approach
Program Integrity, Done Responsibly
Verify: FWA™ is built to support accurate programs and protect
public resources, with human review, due process, and a clear audit
trail. It complements accurate eligibility verification rather than
standing in for staff judgment.
people make them
Compliant and Secure
“It helps our team focus on the cases that matter and document every decision: better stewardship of program dollars, with a clear record.”
HIPAA
COMPLIANT
ARC-AMPE
COMPLIANT
SOC 2
Type 2
SOC 1
Type 2
PCI DSS
Certified
NIST 800-53
Controls
FIPS 140-2
Validated Encryption
Section 1940
Ready
Section 508
Accessible
NASPO ValuePoint
Related Content
Across Verify
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Community engagement and work-requirement verification, configured to your state's exemptions, reporting, and outreach.
Explore Verify: Engage™
Modernize asset verification
Verify: Eligibility™
Electronic asset verification aligned to Section 1940 and ARC-AMPE, returning results into your eligibility workflow.
Explore Verify: Eligibility™
Strengthen program integrity
Verify: FWA™
Program-integrity support that surfaces anomalies thoughtfully, with human review.
Common Questions
What is Verify: FWA?
Verify: FWA supports post-payment program integrity by analyzing data and identifying potentially suspicious activity for further review. Risk assessment and scoring help teams focus investigative resources where they are most needed.
How does Verify support Medicaid program integrity?
Verify combines verification, data analysis, risk assessment, and documented workflows to help agencies identify information that requires additional attention. Verify: FWA extends that approach into post-payment analysis and program integrity.
How does CITIZ3N avoid wrongful denials in program integrity?
HAL keeps a human in the loop. AI surfaces anomalies and patterns; trained staff review and make the determinations, so automation supports decisions rather than making them.
What is HAL?
HAL is Human-Augmented Learning — CITIZ3N's approach to AI where models assist and people decide. It is woven through the Verify modules and never operates autonomously.
How does Verify integrate with Medicaid eligibility systems?
Verify is designed as a modular layer that can exchange data with an agency’s existing eligibility environment. Agencies can add verification capabilities while maintaining their existing core system and workflows.
See Verify: FWA™ in Action
Check out our demo videos or book time with our team.