Effectively prevent Recipient-Fraud
with world-class beneficiary profiling

Did you know:
Medicaid loses ~$29 Billion to fraud annually

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What if Enterprise applications
became socially aware?

Transforming Enterprises with SET Universal Platform

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Time for front-end fraud prevention

Only 5% of the overall 'fraud, abuse and improper payments' committed
are discovered with current efforts

Intelligent fraud prevention matters!

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Its not just about provider credentialing,
but on how well you KNOW YOUR PROVIDER

Gain comprehensive information and intelligence about
providers to support your decision

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Total compliance with PPACA* requirements for
provider screening and enrollment

With the only COTS solution that automates 455 Subpart E
requirements and delivers much more

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* - Patient Provider & Affordable Care Act

Once good, Not necessarily always good

Learn how Digital Harbor delivers unprecedented continuous
provider monitoring towards risk minimization and ACA compliance

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What we do

Digital Harbor, a leader in the field of Fraud Prevention, offers the industry’s most advanced end-to-end operational intelligence suite for detection, investigation, assessment and monitoring of fraud. With its indigenous Social Enterprise Technology (SET) Universal Platform, a next-gen in-house platform, Digital Harbor seamlessly enables collaboration within and between the knowledge workers and all the relevant stakeholders, thus aiding in making informed decisions. Digital Harbor transforms the enterprises from focusing on "better transactions" to "better decisions".

Proven in some of the largest US Financial Institutions and Government Intelligence agencies, Digital Harbor now focuses on U.S. healthcare segment. Digital Harbor is working with Centers for Medicare & Medicaid Services (CMS) to lead automation-based transformation in restructured federal contracts (MAC, ZPIC, RAC, MIC). Digital Harbor is the only COTS ECaM platform, being used in both Medicare and Medicaid contracts. Digital Harbor has already resulted in a cost saving of more than $500 million to its customers in the healthcare segment.

Our Solutions

Know Your Provider

Provider lifecycle management in compliance with ACA requirements for provider enrollment, screening and continuous monitoring.

Know Your

Know Your Audit

Prevents and detects fraud using audits. Provides compliance dashboard, claims analysis and an understanding of overpayments and recovery

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Know Your

Know Your Care-giver

Monitoring long term care employees, including their background screening and rap back for continuous workforce monitoring

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Know Your

Know Your Claim

Facilitates claims' review and adjudication. Includes predictive analytics to detect frauds early and take remediation actions.

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Know Your

Know Your Beneficiary

Effectively prevent recipient-fraud with world-class beneficiary profiling.

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Know Your

What makes Digital Harbor different

What makes Digital Harbor different
Organizations employing knowledge workers have transformed the management of complex and unpredictable processes. Our intelligent software solutions allows our customers to maximize predictability and effectiveness and minimize risks, costs and delays associated with such processes.
- Rohit Agarwal
Meet the Team


  • We chose Digital Harbor because we were convinced that only they provided the complete solution required by us to unearth the risks associated with provider enrollment and management One of the largest Medicaid provider State on selecting the entire KYP suite of products
  • The most exciting thing I have ever seen since Mosaic Vinton Cerf, Father of Internet on PiiE technology
  • Using automated provider screening and monitoring solutions from Digital Harbor, not only we have reduced process times by 75%, but also found exceptions and taken actions which otherwise would have gone unnoticed South-east Medicaid provider state after using KYP Screening and Monitoring


Social Form
Allows organizations to integrate people, their information and communication as part of complex business processes
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Social Case
Only offering which includes all the components required by knowledge workers to manage their complex processes and make well-informed decisions
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Social Analytics
Delivers intelligence in complex business operations helping knowledge workers know their risks better
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What’s trending?... Learn more from our latest blogs

Doctor Shoppers? Not all of them… or are they?

August 31, 2016

Let’s begin with a story – A patient consults a physician for a particular chronic ailment; buys a controlled drug based on the physician’s prescription; not satisfied with the results, visits multiple physicians; gets multiple… View Article

Fraud – not just confined to Providers

August 4, 2016

Medicaid, a federal–state health-financing program for low-income and medically needy individuals, is a significant expenditure for the federal government and the states, with total federal outlays of $331 billion in… View Article

Beyond the Obvious

June 15, 2016

In 2012 Donald Berwick, a former head of the Centres for Medicare and Medicaid Services (CMS), and Andrew Hackbarth of the RAND Corporation, estimated that fraud events (and the extra… View Article

Fraud and abuse – the inconvenient truth

May 11, 2016

Things tend to go wrong if left alone. One of the most popular Murphy’s law states that Anything that can go wrong, will go wrong. To me it’s a loosely coupled adaptation of… View Article

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