Acquisition adds Sleuth© technology and advanced data mining capabilities to strengthen audit precision, reduce mispayments, and enhance payer performance.
Nashville, TN – [October 2, 2025] — HealthWorks today announced the acquisition of Forensic Claims Solutions, a company specializing in contract compliance audits for health plans through its proprietary Sleuth© platform and a library of advanced data mining algorithms. The acquisition expands the capabilities of the HealthWorks Payer Performance Studio, furthering its mission to help payers reduce medical spend, strengthen compliance, and operate with greater efficiency.
Forensic Claims Solutions simplifies complex contract compliance audits by predictively pricing every contract term for every participating provider in a payer’s network. Alongside Sleuth©, the company brings a library of sophisticated, proprietary data mining algorithms that allow payers to identify inappropriate payments with greater accuracy and speed. Together, these innovations provide payers with defensible, predictive insights to prevent mispayments and strengthen contract compliance.
As part of the acquisition, Forensic co-founders Mike McGauley and Craig Mills will join HealthWorks in key leadership roles. McGauley will serve as Executive Vice President of Data Mining Operations, while Mills will serve as Executive Vice President of Data Mining Technology, bringing deep expertise in operational strategy and advanced analytics to the Payer Performance Studio.
“Joining HealthWorks is an exciting opportunity to expand the reach of our Sleuth© technology and advanced analytics,” said Mike McGauley, co-founder of Forensic Claims Solutions and now EVP of Data Mining Operations at HealthWorks. “Our platform and data mining algorithms were designed to give payers defensible, predictive insights into their contracts. Combined with the AI-driven payment integrity solutions being pioneered at HealthWorks, we will deliver unmatched precision and value for health plans nationwide.”
The HealthWorks Payer Performance Studio now offers a robust suite of services, including medical record review, advanced data mining, member monitoring subrogation, provider retraction and collection, credit balance automation, electronic communication, and now contract compliance auditing powered by Sleuth© and proprietary algorithms. Together, these solutions create a proactive approach to payer operations that moves beyond traditional payment integrity into Process Integrity.
“The addition of Forensic Claims Solutions is another step in building the most comprehensive payer solutions platform in the industry,” said Harold Davis, President of HealthWorks’ Payer Performance Studio. “By integrating Sleuth©, leveraging their advanced data mining capabilities, and welcoming Mike and Craig to our leadership team, we’re enhancing our ability to help payers prevent errors, protect relationships, and embed accuracy into the process itself.”
This acquisition reflects HealthWorks’ commitment to aligning payers and providers around clarity, compliance, and trust—delivering measurable results that lower costs, improve compliance, and strengthen relationships across the healthcare system.
About HealthWorks
HealthWorks is a healthcare transformation company committed to aligning payers, providers, and patients around accuracy, efficiency, and trust. By combining innovative technology, operational expertise, and a mission-driven approach, HealthWorks delivers solutions that make healthcare work better for payer, providers, and, most importantly, patients.