What Qlarant does

Qlarant is a not-for-profit organization founded in 1973 as one of the first federally-designated Quality Improvement Organizations (QIOs) for Medicare and Medicaid. Headquartered in Easton, Maryland, the firm operates through three subsidiaries (Qlarant Quality Solutions, Inc., Qlarant Integrity Solutions, LLC, and Qlarant Commercial Solutions, Inc.) to deliver program integrity, fraud waste and abuse (FWA) detection, and quality improvement services to federal agencies including the Centers for Medicare and Medicaid Services (CMS) and the Veterans Health Administration (VA), multiple state governments, and commercial healthcare clients. The firm maintains a 200+ subject matter expert workforce, 100+ certified fraud investigators, and five U.S. offices spanning Maryland, California, Texas, and Florida.

The core technology stack consists of the RIViR Risk Solutions Suite (an AI-driven predictive modeling and risk visualization platform), ClaimsVue Health (a four-tiered scalable FWA claims review platform launched in August 2025 covering FirstLook, Analytics, Discovery, and Recovery workflows), and TENEX for data science applications. These platforms support predictive analytics with disclosed 90%+ accuracy, agentic AI workflows combining RPA and large language models, generative AI for context-based verification, and anomaly detection across Medicare, Medicaid, and commercial claims. Service lines include quality improvement (EQRO/managed care, aging, disability, behavioral health, health disparity solutions), FWA services (audits, medical review, hearings and appeals, call center management, enrollment monitoring), and sector-specific solutions for pharmacy, transportation, unemployment, and pandemic fraud.

Qlarant generates revenue primarily through multi-year government contracts, including UPIC, I-MEDIC, QIN-QIO, and VHA IHT subcontracting, supplemented by professional services engagements and recurring platform licensing for RIViR and ClaimsVue Health. Sales are executed through a direct enterprise field motion with regional program directors managing UPIC contracts across geographies, supplemented by subcontracting relationships and a content-driven marketing strategy targeting program integrity decision-makers at federal and state agencies. The firm also operates Qlarant Capital (early-stage venture investments) and the Qlarant Foundation (grant-making up to $50,000 per organization annually) as affiliated entities.

Name

Qlarant

Legal name

Qlarant

Website

https://qlarant.com

Company type

Private

Founded year

1973

Operating status

Operating

Headcount range

501–1,000 employees

Short description

Qlarant is a not-for-profit founded in 1973 providing fraud, waste, and abuse detection, healthcare quality improvement, and AI-driven data analytics to federal agencies, state governments, and commercial healthcare clients.

Ownership category

akta.pro rank

Product category

Healthcare Program Integrity Services

akta.pro primary industry

Quality Management Systems (QMS) & GxP Documentation (HLAGAKAD)

akta.pro secondary industry

AML/CFT & Financial Crime Compliance (FSAFAOAD)

Keywords

• Program integrity services
• Fraud waste abuse
• Quality improvement services
• Medicare Medicaid auditing
• Risk analytics platform

Headquarters

HQ city

Easton

HQ country

United States

HQ region

North America

Offices8 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure, Others

Revenue model

1. Government Contracts: Qlarant operates primarily as a government contractor, providing program integrity services to federal agencies (CMS, VA) and state governments. Revenue derives from long-term contracts for fraud detection, quality improvement, and compliance services.
2. Quality Improvement Services: Designated Quality Improvement Organization (QIO) and QIO-like entity providing quality improvement services to Medicare and Medicaid programs, healthcare providers, and state agencies. Includes External Quality Review Organization (EQRO) services.
3. Fraud, Waste & Abuse Solutions: Comprehensive FWA services including auditing, monitoring, investigations, predictive modeling, medical reviews, hearings and appeals support. Delivered to government and commercial clients on contract basis.
4. Data Science & Technology Solutions: Technology-enabled analytics services using proprietary platforms like RIViR and ClaimsVue. Software licensing and platform access fees for their AI-driven analytics tools.

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels11 records

Core offering

Qlarant is a not-for-profit program integrity organization founded in 1973 that provides fraud, waste, and abuse (FWA) detection, quality improvement, and data science and technology solutions to federal and state government agencies, healthcare payers, and providers. Its offerings center on predictive analytics delivered through the proprietary RIViR Risk Solutions Suite, the ClaimsVue Health claims review platform, and the TENEX data science solution, paired with professional services in auditing, investigations, medical review, hearings and appeals, EQRO reviews, and quality improvement consulting.

Product overview

Qlarant is a program integrity and quality improvement organization founded in 1973, operating a platform-plus-services model. The core technology products include the RIViR Risk Solutions Suite (which encompasses the RIViR Risk Platform and RIViR Risk Solutions modules) for predictive modeling, risk identification, visualization, and resolution; ClaimsVue Health, a four-tiered scalable claims review platform (FirstLook, Analytics, Discovery, Recovery); and TENEX for data science applications. These platforms are supported by three service pillars: Quality Improvement Solutions (including EQRO/Managed Care, Aging, Disability, Behavioral Health, Health Disparity, Utilization Management, and Training & Education), Fraud, Waste & Abuse Solutions (including Pharmacy, Audits, Medical & Claims Review, Compliance, Enrollment Monitoring, Hearings & Appeals, Call Center Management, Investigations, Pandemic, Transportation, and Unemployment Fraud services), and Data Science & Technology Solutions. Qlarant also operates sector-specific portals (Client Portal, Florida Developmental Disabilities Resources, Georgia Collaborative ASO), the Qlarant Capital investment arm, and the Qlarant Foundation grant-making program. The company holds QIO-like designation and serves federal, state, and commercial clients across healthcare, government, human services, insurance, transportation, and drug pricing markets.

Differentiator

Problem solved

Functional benefit

Brands

• RIViR: Proprietary risk assessment and analytics platform providing predictive modeling, risk identification, visualization, and resolution capabilities
• RIViR Risk Solution Suite
• ClaimsVue Health
• TENEX
• Qlarant Capital
• Qlarant Foundation
• Florida Statewide Quality Assurance Program

Products and services

• RIViR Risk Solutions Suite
• ClaimsVue Health
• TENEX
• Quality Improvement Solutions
• Fraud, Waste & Abuse Solutions
• Data Science & Technology Solutions
• Pharmacy Solutions
• EQRO/Managed Care Solutions
• Aging Solutions
• Disability Solutions
• Behavioral Health Solutions
• Health Disparity Solutions
• Utilization Management
• Training & Education
• Hearings & Appeals
• Call Center Management
• Enrollment Monitoring & Analysis
• Compliance & Due Diligence Audits
• Unemployment Fraud Solutions
• Transportation Fraud Solutions
• Pandemic Solutions
• Veterans Affairs Solutions

Quantifiable outcome

• Over $5 billion in fraud, waste, and abuse identified in four years
• +4 more outcomes

Named customers6 records

Segments6 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability9 records

Feature5 records

Partnerships

Seven partnerships are on record, tiered core and minor.

• IPROcoreStrategic or Co-development Partner · 7 April 2026IPRO was awarded a CMS contract to lead a Quality Improvement Program for the Northeast region including Vermont, collaborating with subcontractors Healthcentric Advisors and Qlarant to improve healthcare quality via technical assistance, data analytics, and training through May 2030.
• Healthcentric AdvisorsminorStrategic or Co-development Partner · 7 April 2026Subcontractor to IPRO on the Northeast Quality Improvement Program alongside Qlarant.
• HRS Consulting, Inc.coreStrategic or Co-development PartnerQlarant is a subcontractor to HRS Consulting, Inc., one of six primes on the Veterans Health Administration (VHA) Integrated Healthcare Transformation (IHT) vehicle. Through this arrangement, Qlarant provides best value healthcare and professional consulting services to the VHA.
• IPRO QIN-QIO NetworkcoreStrategic or Co-development PartnerQlarant is a member of the IPRO QIN-QIO, the Quality Improvement Organization for 11 States and the District of Columbia. Qlarant provides quality improvement for Maryland, Delaware, and the District of Columbia as part of this network.
• NORC at University of ChicagocoreStrategic or Co-development PartnerQlarant supports NORC at the University of Chicago and CMS Office of Minority Health to reduce health disparities in Medicare through quality improvement. NORC sought out Qlarant as a partner based on their work in health disparities and as a designated QIO-like organization.
• Agency for Health Care Administration (AHCA) - FloridacoreStrategic or Co-development PartnerQlarant operates in partnership with Florida's Agency for Health Care Administration as a certified Quality Improvement Organization managing the Florida Statewide Quality Assurance Program.
• Agency for Persons with Disabilities (APD) - FloridacoreStrategic or Co-development PartnerQlarant works in partnership with Florida's Agency for Persons with Disabilities to support individuals with intellectual/developmental disabilities through quality improvement and provider discovery review services.

Scale indicators11 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• IPRO: Quality Improvement Organization and QIN-QIO network lead for 11 states + DC. Qlarant is a subcontractor to IPRO under CMS's Northeast Quality Improvement Program, making IPRO the most directly comparable peer operating the same QIO/QIN designations and serving overlapping state Medicaid and Medicare clients.
• Cotiviti: Healthcare payment integrity and analytics firm serving commercial payers and government programs with claims review, fraud detection, and overpayment recovery workflows. Directly comparable to Qlarant's ClaimsVue Health and FWA Solutions business lines across DME, lab, and pharmacy audit domains.

Broad incumbents

• Optum (UnitedHealth Group): Optum Insight provides healthcare fraud, waste, and abuse analytics, claims integrity, and program integrity services at much larger scale across commercial and government payers. A broader incumbent that overlaps with Qlarant's RIViR/ClaimsVue capabilities but as part of a much wider health-services portfolio.
• Gainwell Technologies (formerly HMS): Major government healthcare services and program integrity provider post-HMS acquisition, delivering Medicaid management, care management, and FWA analytics to state agencies. A broad incumbent in the same healthcare program integrity space with overlapping contract vehicles.
• Maximus: Large government services and program integrity contractor serving federal and state health and human services agencies, including Medicaid eligibility and integrity work. Broad incumbent competing for similar federal program integrity RFPs as a prime contractor.
• LexisNexis Risk Solutions: Data analytics and identity/fraud risk vendor serving healthcare payers, government agencies, and insurance providers with fraud detection and compliance data. Broad incumbent whose healthcare fraud analytics indirectly competes with Qlarant's data-driven FWA offerings.
• Booz Allen Hamilton: Federal consulting prime serving CMS, VA, and HHS on healthcare program integrity, data analytics, and AI/ML initiatives. Broad incumbent competing for similar federal healthcare analytical-services RFx opportunities as both a prime contractor and analytics provider.

Emerging players

• ClarisHealth: Healthcare payment integrity platform purpose-built for health plans and government payers, with AI-driven FWA detection and overpayment recovery capabilities. Comparable emerging player whose technology focus overlaps with Qlarant's ClaimsVue Health and RIViR analytics platform.

Regional players

• Health Management Associates (HMA): Healthcare consulting firm serving state Medicaid agencies, providers, and payers on quality, program integrity, and value-based care initiatives. Comparable niche consultant supporting similar state Medicaid clients but with broader policy/operations focus rather than pure FWA technology.

Others

• SAS Institute: Analytics and AI platform vendor whose anti-fraud, anomaly detection, and government analytics suites are used by Medicare/Medicaid integrity programs as enabling technology. Comparable on the underlying analytics stack that powers Qlarant's RIViR but operates as a software vendor rather than services provider.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key highlights7 records

Customer concentration

• Xx.com/qlarant
• YouTubeyoutube.com/@qlarant
• Facebookfacebook.com/Qlarant
• LinkedInlinkedin.com/company/qlarant

Revenue estimate

Valuation estimate

Number of profiles

Profiles15 records

Subsidiaries1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A1 record

Investments39 records

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Qlarant