Program Integrity Solutions for Government

RELI Group delivers integrated program integrity solutions that help government agencies strengthen oversight, reduce vulnerabilities and protect taxpayer dollars. Our work supports the long-term sustainability of government entitlement programs by reducing exposure to fraud, waste and abuse, and increasing operational transparency. With every engagement, we prioritize efficient outcomes that improve program accountability and ensure critical public services reach the people who need them.

Aligning Teams, Tools and Oversight to Strengthen Government Entitlement Programs

Safeguarding programs requires more than audits or compliance checks – it takes a coordinated effort across expert teams, proven processes and modern technology. RELI brings these elements together to build systems of trust, reduce improper payments and deliver sustained value.

Investigating government fraud, waste and abuse

Experts in Government Fraud, Waste and Abuse Prevention

RELI’s multidisciplinary teams bring deep subject-matter expertise to each engagement, including statisticians, policy analysts, clinical reviewers and fraud investigators. These professionals work closely with agency partners to tailor solutions that reflect the complexity of each program. Our teams are known for delivering strategic, data-informed recommendations that lead to measurable improvements in fraud, waste and abuse prevention.

Coworkers collaborating on program strategy

Data-Driven Oversight for Government Entitlement Programs

Our approach to program integrity is proactive and repeatable. We apply risk-based oversight strategies that help agencies detect issues early before they escalate into larger problems. Through provider verification, claims analysis, and payment validation, we reduce improper payments and strengthen compliance. These methods have supported measurable results, including a 14% reduction in unnecessary drug testing and over $100 million in cost avoidance across federal programs.

Engineers coding systems for federal systems

Tools That Strengthen Program Integrity at Scale

Technology plays a critical role in advancing program oversight. RELI deploys scalable, secure tools that support audits, billing reviews and policy analysis. These solutions reduce manual workload and improve consistency. With automated workflows, we’ve completed more than 60,000 medical reviews and reduced per-review costs by over $100 million, advancing fraud, waste and abuse detection while improving efficiency.

Use Cases

Explore real-world examples of how RELI Group helps government agencies work smarter, respond faster and serve the public more effectively.

Medical billing statement with stethoscope and calculator

Making Every Claim Count: How CMS Ensures Accuracy in Medicare Reviews

To detect fraud and ensure fair payments, CMS needed a trusted partner for reviewing thousands of complex medical claims each month, backed by expert clinical judgment and airtight processes. The Challenge Millions of Medicare and Medicaid claims are processed annually – and not all of them are paid accurately. The Centers for Medicare & Medicaid Services (CMS), through its Center for Program Integrity, needed a way to independently validate whether its contractors were reviewing claims accurately, in accordance with coverage rules, coding guidelines and payment policies. This wasn’t about spot checks. It meant reviewing over 18,000 medical records each year…

How CMS Measures What Matters in Medicare Part C

When CMS needed to report Medicare Part C payment accuracy to Congress, it turned to a process built on precision, expertise and insight. The Challenge Every year, the Centers for Medicare & Medicaid Services (CMS) must report how accurately it pays out Medicare Part C benefits – a requirement under the Payment Integrity Information Act of 2019. The goal: to detect and reduce improper payments due to fraud, waste and abuse. Without a reliable system to calculate and report the Part C Improper Payment Measure (IPM), CMS could not demonstrate compliance to Congress or assess the effectiveness of its payment…

RELI team reviewing records to ensure accuracy

When Accuracy Drives Dollars: Inside CMS’s Medicare Advantage Audit Program

To protect Medicare Advantage payments, CMS turned to a trusted team of coders and clinicians to get the details right. The Challenge The Medicare Advantage program pays health plans based on the health status of its enrollees, using a risk-adjusted model to calculate appropriate reimbursements. But that system is only as accurate as the diagnosis data it’s built on. Inaccuracies can lead to overpayments, underpayments, or missed indicators of fraud, waste and abuse. To protect the integrity of the program and ensure that payments truly reflect patient health status, CMS launched the Risk Adjustment Data Validation (RADV) program. The goal?…