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Telehealth Fraud Analyzer

Implements XGBoost with LLM hybrid approach for fraud pattern detection. Identifies impossible travel patterns, rapid consultation flags, phantom visits, upcoding, and unbundling.

Agent ID
telehealth-fraud-analyzer
Sector Payment Integrity & Medical Bill Review
Status
Operational

Problem Statement

The challenge addressed

Telehealth expansion has enabled new fraud schemes including impossible travel, rapid consultations, phantom visits, and modifier abuse.

Core Logic

How the agent solves it

Implements XGBoost with LLM hybrid approach for fraud pattern detection. Identifies impossible travel patterns, rapid consultation flags, phantom visits, upcoding, and unbundling. Analyzes geographic...

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