Probitas

Program integrity platform: claims analytics, explainable leads, case management, medical review and audit-ready reporting on a governed data platform.

The problem

Program integrity work spans claims data, leads, investigations, reviews and recoveries, often in separate tools. That makes it hard to show how a case was built and what happened next.

Probitas is built for teams who have to explain their work: why a provider was flagged, what evidence was reviewed, and what action followed. Detection results are explainable, and every step of a case is recorded.

Built today

• Claims data ingestion into a columnar analytics store, with reference data management.
• Leads and case management with tracked status, assignments and history.
• Medical review workflow.
• Reporting, administration, and a partner API.
• Tenant isolation enforced in the database, with an audit trail of user actions.

Current status

• Runs on synthetic data only; it has not been used with real claims data.
• Statistical sampling is not yet validated against the standard CMS sampling tool.
• No authority to operate or security authorization documentation yet.