Centers for Medicare and Medicaid Services (CMS)

Center for Program Integrity (CPI)

Since 2018, Reveal has been contracted by the Centers of Medicare and Medicaid Services (CMS) Center for Program Integrity (CPI) to identify waste, fraud and abuse (FWA) in the Affordable Care Act (ACA) Exchanges using artificial intelligence and machine learning techniques. Reveal has leveraged its proprietary Big Data Processing platform– Reveal Analytics Controller (RAC) and AI/ML techniques to help identify anomalous records in the ACA enrollments datasets from Federally Facilitated Exchanges. Reveal has provided CMS CPI with an end-to-end solution that ingests, pre-processes, and analyzes enrollment data while providing deep insights into the data through interactive and user-friendly visualization dashboard. Reveal has leveraged state-of-the-art data ingestion, big data processing, and innovative AI/ML techniques to identify potential instances of fraud, waste and abuse in the ACA Exchanges program.