Claude Analysis of Public Medicare Data Uncovers Billions in Suspected Fraud Patterns

purekarmalabs · reddit · 2026-10-13

A Reddit user prompted Claude to analyze CMS's public 2024 provider-level Medicare data, surfacing multiple suspected fraud patterns. Most flagged companies had already been caught, but several suspicious ones remain in business.

Key findings:

Phantom supplies: one wound-dressing code jumped from $23M to $650M nationally; a Florida supplier billed 62% of it (from $0.6M/<500 patients in 2023 to $860M/127K patients in 2024); a New York supplier went from near zero to $473M; a Pennsylvania firm billed 90% of all drainable ostomy pouch volume.
Falsified orders: of 271 high-volume ostomy-ordering clinicians, 213 are family-practice doctors each with 175 ostomy patients across 40 states at near-identical dollar totals ($500K apiece), while only 15 colorectal surgeons appear — consistent with stolen license numbers attached to never-written orders. Catheters show the same shape: 1,343 of 1,720 orderers are family practice; only 7 urologists in the file.
Unnecessary lab tests: two genetic labs in the same office park billed 23% of national epilepsy panel volume; the larger one grew from $4.6M (2023) to $60M (2024).
Several suspicious suppliers were still enrolled and billing as of the July 2026 file.

The author cautions that outliers don't confirm fraud — report findings to HHS OIG — and will publish a skill file so others can reproduce the analysis.

Original post →

Claude Analysis of Public Medicare Data Uncovers Billions in Suspected Fraud Patterns

More from coding & agent