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From Prediction to Explainable Provider Behavior Profiles for Fraud, Waste, and Abuse Review

arXiv:2609.28477v1 Announce Type: cross Abstract: Claims data can show that provider behavior changed but cannot by itself explain why. FWA (fraud, waste, and abuse) review requires identifying material behavior, locating the codes and dollars driving it, and testing plausible explanations. A commo…

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  1. 2026-09-25 04:00 · arXiv stat.ML
    From Prediction to Explainable Provider Behavior Profiles for Fraud, Waste, and Abuse Review

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