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Fraud, Waste & Abuse Detection Agent

Flags anomalous billing patterns across your provider network and packages the evidence for SIU review.

Who it's for
Payer special investigations unit (SIU) teams.
What it replaces
Manual billing pattern review across a large provider network.
<div class="hx-demo-box" style="margin-top:40px;border:1px solid #D2D2CA;border-radius:12px;overflow:hidden;background:#fff;box-shadow:0 12px 32px -12px rgba(23,25,21,.18)"><div style="background:#F7F7F3;border-bottom:1px solid #D2D2CA;padding:10px 20px;display:flex;align-items:center;gap:10px"><span style="width:11px;height:11px;border-radius:50%;background:#E4E4DE"></span><span style="width:11px;height:11px;border-radius:50%;background:#E4E4DE"></span><span style="width:11px;height:11px;border-radius:50%;background:#E4E4DE"></span><span style="font-size:12px;color:#8B9086;margin-left:6px">siu.local/providers/PT-network</span></div><div style="padding:20px 22px 4px"><div style="font-size:11px;letter-spacing:0.06em;text-transform:uppercase;color:#585D54;margin-bottom:14px;font-weight:600">CPT 97110 monthly volume, PT network</div><div style="display:flex;flex-direction:column;gap:12px"><div style="display:flex;align-items:center;gap:12px;animation:fadeUp .3s ease both"><span style="flex:0 0 70px;font-size:12px;color:#585D54">#11840</span><div style="flex:1;height:20px;background:#F3F4F0;border-radius:4px;overflow:hidden"><div style="height:100%;width:24%;background:#D2D2CA;border-radius:4px"></div></div><span style="flex:0 0 60px;font-size:12px;text-align:right">412/mo</span></div><sc-if value="{{ r2 }}"><div style="display:flex;align-items:center;gap:12px;animation:fadeUp .3s ease both"><span style="flex:0 0 70px;font-size:12px;color:#585D54">#11841</span><div style="flex:1;height:20px;background:#F3F4F0;border-radius:4px;overflow:hidden"><div style="height:100%;width:22%;background:#D2D2CA;border-radius:4px"></div></div><span style="flex:0 0 60px;font-size:12px;text-align:right">380/mo</span></div></sc-if><sc-if value="{{ r3 }}"><div style="display:flex;align-items:center;gap:12px;animation:fadeUp .3s ease both"><span style="flex:0 0 70px;font-size:12px;font-weight:700">#11842</span><div style="flex:1;height:20px;background:#F3F4F0;border-radius:4px;overflow:hidden"><div style="height:100%;width:100%;background:#E0554F;border-radius:4px"></div></div><span style="flex:0 0 60px;font-size:12px;text-align:right;font-weight:700;color:#8A2E29">1,680/mo</span></div></sc-if></div></div><sc-if value="{{ isDone }}"><div style="margin:16px 22px 20px;padding:14px 16px;border-radius:8px;background:#FCEFED;font-size:13px;color:#8A2E29;animation:pop .4s ease both">&#9888; Provider #11842 bills 3.4x the peer average, with same-day billing on 98% of visits and no supporting notes on file. Estimated exposure $184,000. Routed to SIU queue.</div></sc-if></div>
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Scan your own network →
Free to start. No credit card.

How the Fraud, Waste & Abuse Detection Agent works

1
Ingests claims data
Ingests claims data
Pulls billing patterns across providers and time.
2
Detects anomalies
Detects anomalies
Flags outlier billing patterns compared to peer providers and historical baselines.
3
Ranks by risk
Ranks by risk
Prioritizes flagged providers by dollar exposure and pattern severity.
4
Step label
Routes to SIU
Packages the evidence for investigator review.
5
Step label
$184K
average flagged exposure per case
3.4x
peer average, the threshold that triggers a flag
60%
faster SIU investigation cycles

See what's hiding in your billing data.

Start free, we'll scan a sample of your real claims data and show you the flags.

Benchmarked against your own provider network, not a national average
Every flag comes with a dollar exposure estimate
Free scan on your first 90 days of claims
Starts free
Takes about 30 seconds. No sales deck required.
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