This prototype app ingests data feeds from EDI or FHIR and detects potential Durable Medical Equipment (DME) fraud events in real time. Anomalies detected in the data feeds trigger investigation processes which are prioritized by the system based on likelihood and severity of the fraud. Data for the application is stored in the Xenese blockchain for immutability and auditability.
The investigator can open a task to see the details of the anomaly, and explore the related information.
They can access standard policies and procedures to help determine the next steps. If appropriate, they can assign the investigation to another agency.