fraud-detection Skill
Screen a Medicare/Medicaid claims corpus for fraud, waste, and abuse and produce ranked, fully-cited investigation referrals for an SIU / program-integrity team. Use when asked to run a fraud sweep, screen claims for FWA, find billing anomalies, or generate investigation referrals over a claims dataset. Published by anthropics in healthcare.
What is fraud-detection Skill?
Screen a Medicare/Medicaid claims corpus for fraud, waste, and abuse and produce ranked, fully-cited investigation referrals for an SIU / program-integrity team. Use when asked to run a fraud sweep, screen claims for FWA, find billing anomalies, or generate investigation referrals over a claims dataset. Published by anthropics in healthcare. This profile combines repository metadata with install, compatibility, and usage signals so developers can quickly decide whether it fits their agent workflow before opening the source repository.
Automated repository signals based on public metadata such as recency, license, installation evidence, and adoption. These are not a security audit or endorsement.
Key capabilities
- Includes SKILL.md support
- Reusable instructions support
- Database workflows
- Data analysis
- Database workflows use cases
- Data analysis use cases
Technical details
- Install or run with Copy skill directory
When to use fraud-detection Skill
- Use it for database workflows.
- Use it for data analysis.
Built with
Editorial notes
Source
- Creator: anthropics
- Repository: anthropics/healthcare
- Skill file: plugins/healthcare/skills/fraud-detection/SKILL.md
What it does
Screen a Medicare/Medicaid claims corpus for fraud, waste, and abuse and produce ranked, fully-cited investigation referrals for an SIU / program-integrity team. Use when asked to run a fraud sweep, screen claims for FWA, find billing anomalies, or generate investigation referrals over a claims dataset.
Skill instructions
Fraud Detection — claims screening → cited investigation Screens a Medicare/Medicaid claims corpus against the public rulebook (NCCI MUE, OIG LEIE, CMS enrollment, PFS) and produces ranked, fully-cited investigation referrals for an SIU. The skill orchestrates a three-tier investigation: a deterministic floor does the detection, the model judges and narrates on top, and every dollar/rule allegation traces back to the floor. Output framing - "Indicators consistent with [scheme]," not "fraud." A pattern match doesn't establish intent — that's a downstream investigative/legal determination. This is standard SIU language and the framing the renderers use. - Render for review. The skill writes packets to $CLAUDEHEALTHCAREDATA/fraud-detection/out/; the payer's SIU workflow decides what to do with them. The model does not send/publish on its own. Inputs - The payer's claims in corpus.duckdb (canonical 6-table schema: claims-schema.sql). Getting this is step 1 below — without it nothing else m
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Frequently asked questions
What is fraud-detection?
fraud-detection is a open-source AI agent skill with Copy skill directory. Screen a Medicare/Medicaid claims corpus for fraud, waste, and abuse and produce ranked, fully-cited investigation referrals for an SIU / program-integrity team.
Who is fraud-detection best for?
fraud-detection is best for reusing agent instructions, scripts, and references, database workflows, data analysis workflows.
How do I install fraud-detection?
Install or run fraud-detection using Copy skill directory. Check fraud-detection for the latest setup command.
Is fraud-detection actively maintained?
fraud-detection may need a closer maintenance check before production use.
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