Upcoding, cloned documentation, and falsified treatment plans are there. They’re just hard to see.
Behavioral health is characterized by large volumes of documentation occurring over time captured in clinical notes, claims, and treatment plans.
Differentiating legitimate care variation from abuse makes pattern detection and individual claim reviews essential, but few plans have the tools to flag irregularities at scale.
Program integrity that runs ahead of the problem
Onos doesn’t just identify fraud, it protects members and helps you direct your dollars toward the care that actually works.
3 %
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Automated oversight, configured to your plan’s clinical standards and policies
Onos translates your plan's policies into automated, population-level oversight, interpreting claims alongside raw clinical documentation to flag inconsistencies, unsubstantiated claims, and cases that warrant immediate review.
Atypical pattern detection
Onos automatically scans clinical documentation and claims for fraud and abuse. Overlapping or irregular provider schedules, inflated authorization requests, and billing that doesn’t align with clinical documentation are all automatically flagged for review.
Documentation integrity review
Identify non-individualized notes, missing or incomplete assessments, and unsupported goal changes that indicate low-quality or fraudulent care.
Population-level oversight
Monitor your entire behavioral health population continuously, not just on audit cycles, with full visibility into provider behavior across every member interaction. Direct members toward trusted, outcomes-aligned care and away from low-quality or high-risk providers before harm compounds.
Policy alignment
Automatically compare clinical documentation against your plan’s standards and flag cases that don’t match the care billed. Route high-risk cases to your Special Investigations Unit with clinical evidence packets automatically assembled and ready for their review.
“Audit cycles have historically made program integrity a reactive process. With Onos reviewing treatment plans and claims in real time and flagging potential fraud and abuse immediately, plans can finally move toward proactive, early interventions.”
Rebecca Schecter , former CEO of Optum Behavioral Health