Fraud, Waste, & Abuse

Vimo offers states more than fraud response – we design proactive program integrity into every solution.

Our approach to managing fraud, waste, and abuse (FWA) has grown out of decades of experience working within and alongside state agencies. Whether we’re partnering with state health exchanges, child care, child welfare, Medicaid, SNAP, TANF, or other public service programs, our unified approach to integrity is rooted in the following beliefs.

Fraud is a structural risk, not an isolated event. 

Program integrity succeeds or fails at the system level, not because of a single bad actor or special situation. Instances of FWA tend to follow recognizable patterns, including:

  • Complex or inconsistently applied eligibility rules
  • Fragmented or delayed data validation
  • Loosely coupled provider authorization and payment systems
  • Operational backlogs that are easily overlooked
  • Oversight too heavily dependent on post-payment review

We use this awareness to design solutions that prevent FWA at the system level. 

Integrity starts upstream – where eligibility and authorization begin. 

Prevention works best when it’s built into everyday workflows and information is verified in real time. Instead of focusing FWA efforts on downstream activities, Vimo aims to identify and mitigate risks when they first arise. This includes:

  • Validating information early, before coverage is established 
  • Applying rules consistently across applicants and renewal cycles 
  • Treating eligibility and redetermination as continuous processes 
  • Aligning payment eligibility and reconciliation 

Proactive Measures in Action

The Wyoming ECARES child care solution offers an example of our upstream FWA philosophy. Rather than relying on retroactive audits alone, the solution enforces alignment between authorized care, verified attendance, and payment eligibility, reducing the likelihood of improper or fraudulent payments before funds are released.   

Consulting that aligns policy and practice reduces risk. 

Fraud risk often grows in the space between policy and practice, where rules are sound, but operational approach and controls may vary. To optimize alignment between policy, people, and processes, our FWA work focuses on: 

  • Making work visible and consistent 
  • Reducing operational variations that bad actors may exploit 
  • Clarifying handoffs and accountability 
  • Aligning timing, data, and decision points 

Technology is the foundation, not the entire solution. 

Technology is a key part of FWA, but alone, it isn’t sufficient. Our solutions leverage a combination of technological and human oversight measures to ensure program integrity: 

  • Rules-driven eligibility and compliance checks 
  • Role-based access to prevent unauthorized actions 
  • End-to-end audit trails for every decision 
  • Continuous, event-driven verification 
  • Exception-focused human review 

Integrity Without Sacrificing Access

Agencies may fear that increasing FWA controls will lead to delayed access or present burdens for individuals and families, but our experiences show the opposite. Our approach has shown, time and again, that efficiency is not incidental to integrity – it is integral to it. By increasing consistency, transparency, reliable data validation, and early issue identification, programs can increase integrity and public trust while improving efficiency, allowing more individuals and families to access services when they need them.