Fraud prevention, not fraud detection
Healthcare fraud is a $100B problem. The fix starts at enrollment.
Bad actors enroll as Medicare providers with fake credentials and stolen identities. They bill millions before anyone notices. Fraudless flags them at enrollment — before a single fraudulent claim is paid.
The problem
The system catches fraud after the money is gone
Medicare and Medicaid pay out over $1 trillion in claims every year. More than $100 billion of that goes to fraud — fake clinics, phantom providers, billing schemes run by organized rings. That's $270 million a day walking out the door.
The entire system is reactive. A provider enrolls, submits claims, gets paid. Months or years later, an auditor flags suspicious patterns. By then the provider has closed shop, the money is offshore, and recovery is pennies on the dollar.
We don't have a fraud detection problem. We have a fraud prevention problem.
$100B+
Stolen from Medicare and Medicaid annually (CMS/OIG estimates)
$270M
In fraudulent claims paid every single day
Reactive
The current playbook: pay first, detect later, recover almost nothing
The thesis
Stop fraud at enrollment. Everything downstream gets simpler.
How it works today
Detect & Recover
- 01Provider enrolls with fake credentials
- 02Bills Medicare for months or years unchecked
- 03Audit flags suspicious billing — eventually
- 04Investigation. Litigation. Pennies recovered.
How Fraudless works
Prevent at the gate
- 01Provider submits enrollment application
- 02Fraudless analyzes credentials, entity networks, behavioral signals
- 03Fraud rings, phantom providers, and stolen identities flagged
- 04Bad actors denied before billing a single dollar
Every dollar of fraud prevented is a dollar that never needs to be investigated, litigated, or recovered. Prevention isn't just cheaper than detection — it's a different order of magnitude.
The product
Screen every enrollment application. Flag what matters.
Cross-reference PECOS enrollment data, NPI registries, and entity ownership networks. Surface the shell companies, revoked credentials, and phantom providers that slip past manual review.
| Provider | Risk | Status |
|---|---|---|
Apex Medical Group LLC Group Practice · FL · Jan 14, 2024 | 94 | flagged |
Dr. Maria Santos, MD Individual · TX · Jan 14, 2024 | 12 | approved |
Pacific Home Health Services Home Health · CA · Jan 13, 2024 | 78 | review |
Sunshine DME Supplies Inc DME Supplier · FL · Jan 13, 2024 | 87 | flagged |
Dr. James Whitfield, DO Individual · NY · Jan 12, 2024 | 8 | approved |
Apex Medical Group LLC
NPI 1548293716 · Group Practice · FL
Enrolled Jan 14, 2024 · Application ENR-2024-4892
Risk Signals
Confidence
3 of 3 risk models flagged this application
Entity Network
The team
We've built fraud detection for the federal government. Now we're building it right.
We built enrollment fraud screening inside the federal healthcare system — the tools that analyze provider applications for the largest healthcare payer in the country.
We know the data, the procurement process, who signs the contracts, and exactly where the current systems break down. That's not research — it's operating experience.
Most teams in this space will spend years learning the domain. We've been operating in it.
The market
Every payer in healthcare has a front door. None of them are locked.
Provider enrollment is how every bad actor enters the system. CMS is where we start — state Medicaid agencies and commercial payers are where we go next.
CMS
Medicare & Medicaid — $1T+ in annual claims, the biggest target
50 States
Every state Medicaid agency runs its own provider enrollment
Commercial
UnitedHealth, Elevance, Cigna — same fraud vectors, same exposure
Oversight
OIG, DOJ Healthcare Fraud Unit, state investigative agencies
The front door to healthcare is wide open. We're closing it.
If you work in healthcare fraud, enrollment integrity, or payer operations — we should talk.
[email protected]