Revolutionizing NEMT Fraud Prevention
At MTM Health, we’re at the forefront of safeguarding non-emergency medical transportation (NEMT) benefits and federal funding through innovative technology and unwavering human expertise. Our pioneering fraud, waste, and abuse detection and investigation process integrates artificial intelligence (AI), machine learning, and robotic process automation to proactively identify and prevent misuse—before it impacts our clients and NEMT programs.
Unlike traditional reactive methods, we anticipate risks, fostering a culture of detection and prevention that’s embedded across every part of our organization. No other NEMT broker is investing in these advanced capabilities or delivering comparable results.
Harnessing AI and Machine Learning for Fraud Detection
Our proprietary AI-driven dashboards empower our teams with insights to spot anomalies and hidden fraud schemes. These tools use advanced machine learning algorithms for automated pattern recognition, analyzing vast datasets to detect irregularities such as unusual trip distances, frequent rides outside NEMT benefit protocols, or suspicious relationships between drivers, members, and routes.
Our approach includes:
Predictive Modeling for Signal Generation
Enterprise Dashboards for Visibility and Prioritization
Automated Action Items for Execution and Accountability
High-risk cases are automatically linked and flagged for escalation. This ensures quicker responses, minimizes financial impact, and refocuses manual efforts on legitimate concerns.
We’ve expanded this approach from gas mileage reimbursement—where it first proved its value—to all transportation modes. For instance, our MTM Link Member mobile app streamlines reimbursement submissions while mitigating fraud through geocoding verification. Claims are denied if the member’s location is more than 1/10 of a mile from the reserved addresses, ensuring accuracy and
MTM Link: Preventing Fraud
- Geocoding for claim verification
- Watchlists for high-risk members/providers
- Real-time alerts for CCRS
Our unified MTM Link platform further enhances early detection by confirming member eligibility, matching provider files to scheduled trips, and generating exception reports for auditors. Suspicious activity triggers fraud alerts, placing members on watch lists and prompting pre-trip verifications, such as contacting medical providers to confirm appointments.
All of this is powered by a completely private, HIPAA-compliant AI model tailored exclusively for MTM Health, optimizing costs, ensuring compliance, and limiting losses through efficient, early intervention.
The Essential Human Touch: Expertise in Every Step
While AI and machine learning are critical for rapidly identifying potential issues, we firmly believe technology supports, but never replaces, human judgement. Every flagged concern undergoes thorough review by our Special Investigations Unit (SIU) team of experts. They determine whether it constitutes fraud, waste, abuse, or misuse, and respond appropriately, from canceling trips to escalating for further action.
This “human in the loop” approach ensures accountability, ethical handling, and precise outcomes. Our fraud prevention isn’t siloed in Compliance or IT—it’s a shared enterprise capability, where predictive models, dashboards, and action items work in concert to drive execution while maintaining human oversight for fairness and accuracy.
Proven Results: Delivering Real Savings and Impact
The impact of our AI-enhanced FWA process is measurable and transformative. In 2025, we proactively flagged and investigated 23,000+ cases of potential fraud. Of these cases, 37% were deemed valid, generating more the $3 million in loss avoidance. Approximately two-thirds of the valid cases were member-generated fraud, while the remaining were transportation provider-generated.
These figures demonstrate how our integrated system not only detects risks at scale but also quantifies savings, operational ROI, and compliance evidence.
Success Stories: Leading the Way Across States
Our innovative approach is also earning recognition and driving change nationwide:
- One statewide client in the northeast is adopting our FWA dashboards as a benchmark, holding its other vendors to MTM Health’s high standards.
- For a health plan in the midwest, based on AI-detected patterns, we’ve recommended program enhancements like credentialing requirements for gas mileage reimbursement payees to curb fraud.
- In two states, we’re collaborating with the Office of Inspector General (OIG), sharing data and fraud indicators from our machine learning models to support of state-wide prevention efforts.
- For one large statewide client in the midwest, we’re leveraging our AI model to proactively prevent transportation provider fraud, setting new standards for accountability.
MTM Health is committed to a connected system where AI innovation meets human expertise, ensuring NEMT benefits are protected, efficient, and trustworthy. By anticipating risks and acting decisively, we’re not just preventing fraud—we’re building a stronger, more sustainable healthcare transportation ecosystem.
