Healthcare Program Integrity Analytics

Advanced analytical frameworks analyzing Medicare billing patterns, provider behavior, and healthcare access across federal programs serving millions of Americans

8
Analytics Projects
99.1%
Peak Accuracy
29.5M
Beneficiaries Analyzed
3,198
Counties Covered

Research Projects

Comprehensive analytical frameworks addressing critical challenges in U.S. healthcare

01

Medicare Part D Prescriber Risk and Compliance Analytics

Machine learning system analyzing 1.38 million Medicare prescribers to identify program integrity risks and compliance violations through temporal validation.

1.38M Prescribers Analyzed
72.5% AUC Score
02

Medicare Part D Opioid Prescribing Integrity Analytics

Risk scoring framework analyzing 1.03 million prescribers to identify high risk opioid prescribing patterns through peer benchmarking and triple validation.

1.03M Prescribers
61.6% Concordance
03

Medicare Part B Drug Waste Anomaly Detection

Anomaly detection system for injectable drug waste achieving 100% recall with federal validation concordance across 824 medications analyzed.

824 Drugs Analyzed
100% Recall
04

DME Program Integrity Analytics System

Comprehensive anomaly detection protecting vulnerable beneficiaries from high risk durable medical equipment suppliers through dual method validation.

94.2% Accuracy
198K Records
05

Medicare Telehealth Program Integrity System

Advanced system addressing COVID 19 telehealth expansion vulnerabilities with validated statistical precision for critical risk provider identification.

50K Providers
100% Precision
06

Medicare Billing Integrity Detection System

DRG manipulation detection across 2,911 facilities with 88% PEPPER concordance and systematic risk stratification framework.

2,911 Facilities
94.3% Accuracy
07

Home Health and Hospice Program Integrity

Triple validated detection system protecting vulnerable populations requiring home based and end of life care services across 12,112 agencies.

12,112 HHAs Analyzed
91.7% Precision
08

Medicare Program Integrity and Healthcare Equity

County level framework analyzing all 3,198 U.S. counties achieving 98.4% HRSA concordance in identifying healthcare access disparities.

99.1% Accuracy
98.4% HRSA Concordance

About

Healthcare Data Analytics Specialist

I specialize in developing advanced analytical systems that protect federal healthcare programs from improper billing while improving access for vulnerable populations. My work focuses on creating reproducible, validated frameworks that federal agencies can immediately deploy.

Through rigorous statistical methods and machine learning techniques, I have developed analytical frameworks analyzing millions of Medicare claims and providers, achieving validation rates exceeding 98% against federal benchmarks including HRSA, CMS, and MedPAC.

Technical Expertise

Advanced Statistical Methods
Machine Learning Classification
Federal Healthcare Data Systems
Medicare Payment Systems
Healthcare Program Integrity
Health Equity Analytics
Policy Integration
Production Implementation