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Fraud, waste & abuse intelligence

Find the fraud, waste and abuse. Give your team a clearer path to action.

Orion helps insurers identify unusual claims and provider behavior, prioritize high-impact cases, and gather the evidence needed to make informed decisions before payment.

Request a retrospective assessmentSee the evidence
Claims and providers, seen as a network over timeStableWatchNeeds review
Why this matters

A small fraction causes most of the waste. Everyone else pays for it.

The vast majority of providers bill honestly. But the controls built to catch the few have landed on all of them: prior authorizations, documentation requests, delayed payments, delayed care.

Orion is built to lift that friction off the many by seeing the few clearly.

Providers billing honestly, carrying the frictionThe few driving most of the waste
Years ahead

Suspended in 2026. Flagged by Orion in 2020.

Backtested against real CMS exclusion outcomes, using only data known at the time.

CMS acts in 2026.

CMS suspended or excluded a group of providers.

Orion had flagged them by 2020.

Orion had flagged every one of them as suspicious years earlier: all by 2020, a third as early as 2015.

Your team could have saved it all.

Every payment made to them in between would have gone to your team for review. All of it could have been saved.

How Orion works

From every claim to the few worth a closer look.

Orion is three things working together: a fraud, waste and abuse risk assessment on every claim before payment, agentic workflows that do the legwork, and intelligence shared across participating insurers. It shows where exposure is concentrated, why a claim or provider surfaced, and what to do next.

Every claim, before paymentORIONClean claimsmove through without delayA closer lookrouted to your team, with the context already gathered
Every claim, before paymentORIONClean claimsmove through without delayA closer lookrouted to your team, context already gathered
FWA risk assessment
Every claim is assessed for fraud, waste and abuse before payment, and ranked by risk, by financial exposure and by the evidence available, tuned to your guidelines.
Agentic workflows
Approved AI workflows do the legwork: gathering records, requesting member verification, laying out the evidence for review. Your team keeps every claim decision.
Shared intelligence
Confirmed findings sharpen future scoring. If you opt in, approved provider-level findings are shared across participating insurers, never member or claim data. How sharing works →

Go beyond individual claim edits.

A claim edit asks one question. Orion asks three more of the same claim, and says why it surfaced.

A claim edit

Does it pass the rule?

One transaction at a time. Where it stops.
What Orion adds
Over time

Does this provider’s pattern fit, over time?

Against peers

How does it compare with peers?

With context

Does it fit the member’s context?

The signal
A closer look, and why
Provider patternUnusual volumeNo matching visit
Your team decides.
Illustrative
Why prepayment

Get it right the first time.

Recovering payments after the fact is slow and costly, and it strains provider relationships. Orion helps resolve questions while the claim is still a claim.

With Orion: claims stream into Orion. Nearly all pass straight through and are paid, instant or same as today. The few that are flagged go straight to your team: agents gather records, verify the member and prepare the case, and a team member, drawn above the decision ring and joined to it, decides in Orion. The claim is then paid or stopped, instant or next batch. PAID STOPPED Your team Agents prepare · your team decides Gathers recordsMember verificationPrepares the case decides flagged Claims ORION With Orion: claims stream into Orion. Nearly all pass straight through and are paid, instant or same as today. The few that are flagged go straight to your team: agents gather records, verify the member and prepare the case, and a team member, drawn above the decision ring and joined to it, decides in Orion. The claim is then paid or stopped, instant or next batch. PAID STOPPED Your team Agents prepare,your team decides Gathers recordsMember verificationPrepares the case decides flagged Claims ORION

Every claim, reviewed the instant it arrives. The few are stopped before payment, not chased after it.

  • Paid
  • Flagged
  • Stopped
  • Clean claims pass straight through. Paid instantly or on your normal schedule, with no new step.
  • The few are flagged, not stalled. Agents gather the records and prepare the case; your team decides in Orion, sooner, not months later.
  • Improper payments are stopped before they go out. Nothing to chase months later.
What makes Orion different

A data and risk intelligence ecosystem. Not a one-sided tool.

Orion

Orion is a game-changer on its own.

Orioncomplete on its own

Decided before payment

Flagged before payment, ranked by risk, exposure and evidence, and decided by your team.

Paired with Eterna and the Longevity App

A force multiplier on value and ROI.

EternaAbout Eterna
Longevity App
OrionIdentify suspicious claims and decide

Decide with clinical context

Longitudinal health data make it easier for a reviewer to make a decision faster.

Verified by the member

Ask the member by app, text, email or your own app.

Orion stands on its own. Eterna and the Longevity App build on it.

See the evidence
Optional shared intelligence

Learn from confirmed findings.

A provider rarely bills just one insurer. Like MIB in life insurance, participating insurers can choose to share approved provider-level findings, so each one benefits from what the network has confirmed. Participation is optional, and changes to scoring are reviewed.

✓Shared, if you opt in: approved provider-level findings and case outcomes
✕Never shared: member-level data, claim-level data, clinical records or provider reimbursement
YOUINSURERINSURERINSURERINSURERSHAREDINTELLIGENCEOne provider,many insurers
Lines of business

Built for the lines you write.

Orion is live on Medicare Supplement claims today, and is being extended across healthcare and then beyond it.

Healthcare

Medicare SupplementIn production on claims today
Live
Expanding to
  • Medicare Advantage
  • Commercial
  • Medicaid
  • Value-based care organizations
Beyond healthcare
  • Long-term care
  • Disability income
  • Workers Compensation
Getting started

Start with a retrospective assessment.

A retrospective assessment identifies priority exposures, evidence for investigation, operational next steps and an estimated savings opportunity. Twelve months of historical claims is a preferred starting point; shorter histories can be considered. Timing and scope are confirmed by line of business, data readiness and the agreed assessment.

Any claims systemWorks with the claims system you already have. Your team decides in the tools it already uses.
Days or weeksUp and running in days or weeks, not months or years.
ASSESS
Retrospective assessment and readout
DECIDE
Business case
DEPLOY
Implementation
MEASURE
Launch and ongoing insights

See what is worth investigating, and what a practical deployment could deliver.

Start with a retrospective assessment on your own claims.

Assess your claims