DME Phantom Schemes: How to Leverage AI and Data Analytics

Sponsored by: Healthcare Fraud Shield

The rise of “phantom providers” in Durable Medical Equipment (DME) fraud reflects the growing sophistication of healthcare schemes. This session explores how Healthcare Fraud Shield’s multi-layered defense system proactively detects and prevents these threats.

We’ll demonstrate how our approach combines:

• Artificial Intelligence (AI): Models trained on real-world fraud patterns detect subtle anomalies and predict emerging threats that traditional rules may miss.

• Targeted Analytics for DME: Designed to identify:

• • Dormant providers suddenly spiking in billing.

• • Geographic outliers with abnormal billing patterns.

• • Unusual combinations of DME products or services.

• • Excessive or medically unnecessary quantities of DME.

• External Data Integration: Leveraging the National Provider Identifier (NPI) file and other sources to:

• • Validate provider legitimacy.

• • Identify shell entities or false identities through cross-referenced billing behavior.

Real-world, anonymized case studies will illustrate how this holistic strategy—combining AI, targeted analytics, and external data—creates a powerful shield against complex fraud schemes, protecting healthcare resources and ensuring payment integrity.

Speaker: 

Karen Weintraub
Executive Vice President, Healthcare Fraud Shield

Please note: This event is sponsored by Healthcare Fraud Shield, an NHCAA Platinum Supporting Member. Registration is limited and determined by the sponsor, and NHCAA cannot circumvent or alter the sponsor’s registration policies. Registration from personal email addresses and some organizations are not permitted. Please accept our apologies if you are unable to register for this particular event, however, NHCAA does offer other educational programs. Please click here to view upcoming educational opportunities.