Spot billing fraud,subsidy leakage, and insidercollusion in regulated ecosystems.

From false claims to subsidy diversion, fraud drains millions from health and public programs. RaptorX prevents $10–30M+ in annual losses while simplifying audits and compliance reporting.

Key Challenges

Inflated or False Billing

Fraudulent providers submit exaggerated or entirely false claims — often under real patient IDs — leading to massive silent losses.

Phantom Clinics & Shell Hospitals

Non-existent or paper-only clinics generate high-volume claims without delivering actual care, bypassing basic system checks.

Insider Collusion

Internal staff collaborate with external entities to push claims, bypass rules, or manipulate approvals without detection.

How RaptorX Solves It

Claims–Provider–Flow Mapping

RaptorX connects claims data, provider IDs, patient profiles, and payment flows into a unified fraud graph.

Collusion Ring Detection

Detects hidden relationships and behavioral anomalies that suggest collusion — even when labels are missing.

Explainable Compliance Insights

Surfaces patterns in clear, regulator-friendly language and visuals for faster action by compliance and audit teams.

Impact Metrics

$10–30M/year in false claims prevented →across health networks

3× increase in detection of internal collusion →and provider abuse

Simplifies audit prep with case-ready outputs →and explainability