Medicare Part B Drug Waste Anomaly Detection & Program Integrity System

Real-time monitoring of drug waste patterns across 824 injectable drugs and 1.2M providers

$1.87B
Annual Drug Waste
$189.7M
Anomalous Patterns Identified
$132.8M
Annual Recoverable
824
Drugs Analyzed
1.2M
Provider Records
92
High-Risk Drugs
1,328x
Return on Investment
Every $1 invested yields $1,328 in recoverable improper payments
Geographic Distribution of Anomalies
Risk Grade Distribution (824 Drugs)
10-Year Savings Projection
Specialty Waste Patterns

Implementation Roadmap

I
Phase I: Pilot Deployment (Years 1-2)
5 high-risk states • 10,000 providers • $47M-$132M annual savings • Real-time modifier compliance
II
Phase II: National Rollout (Years 3-5)
Nationwide coverage • 1.2M providers • $265M-$487M annual savings • NLP integration
III
Phase III: Cross-Program Expansion (Years 5+)
Medicaid, TRICARE, VA • $500M-$700M annual savings • Predictive modeling • $1.7B-$2.3B total
Model Performance Metrics
81.8%
F1-Score
100%
Recall
69.2%
Precision
87.3%
Accuracy
0.924
AUC-ROC
4.7hrs
Processing Time
Top 5 High-Risk Drugs by MWARI Score
Rank HCPCS Drug Name MWARI Score Waste Rate Financial Impact
1 J3299 Injection, triamcinolone 95.5 81.6% $1,616,004
2 Q9965 Low osmolar contrast material 92.2 68.4% $1,460,356
3 J9281 Mitomycin injection 89.3 44.3% $16,967,542
4 J3101 Injection, tenecteplase 87.4 33.2% $11,473,212
5 J9043 Cabazitaxel injection 86.0 31.0% $38,553,000
Key Impact Statistics
2.3x
Higher waste in rural areas
85.9%
Waste in 11.2% of drugs
2,656
Nurse practitioners fundable
1.3M
Beneficiaries covered