DME Program Integrity Analytics System
Identifying High-Risk Patterns in Medicare Durable Medical Equipment Claims
Annual Improper Payments
$4.66B
Identified across 2,246 suppliers
High-Risk Suppliers
2,246
5% of 44,918 analyzed
Beneficiaries Affected
2.76M
Experiencing unusual billing
Return on Investment
1,000:1
$46.6B projected 10-yr savings
Top 5 States by Improper Payment Impact
System Performance Metrics
Model Validation Results
Detection Accuracy
94.2%
Precision Rate
87.3%
Recall Rate
71.6%
F1 Score
78.6%
Implementation Roadmap & Financial Impact
Phase I: Real-Time Monitoring
Years 1-2
$1.2-3.3B
Annual Recovery • ROI 240:1-660:1
Phase II: Network Detection
Years 3-5
$4-6.5B
Annual Savings • 3-4M Protected
Phase III: National Integration
Years 5+
$8-10B
Annual Prevention • $80B/decade
Extreme Outliers Detected
Annual Trend Analysis (2021-2023)
Risk Score Distribution Across Suppliers
35,934
Low Risk (0-50)
6,738
Medium (50-75)
1,796
High (75-90)
405
Critical (90-99)
45
Extreme (99+)
18-24
Months Earlier Detection
100x
Coverage Improvement
1,166x
Max Billing Anomaly
3.4x
Predictive Lift