Protocol
Validation protocol: institutional self test for provider level fraud detection in federal healthcare programmes
- Identifier
AYENI-2026-0010 - Version1
- Published2026-05-30
- AccessTier 1: public
Description #
A twelve stage, eight gate self test that lets a state Medicaid programme integrity unit, HHS OIG contractor, Medicare Administrative Contractor, or Unified Program Integrity Contractor determine whether provider level fraud detection works on its own claims data, entirely inside its own environment, without contacting the author or sending any data anywhere. Every stage has a written stop condition and the acceptance criteria are fixed before results are seen. The blind investigator review, the only stage that measures value rather than a proxy for it, is placed last by design, and a one page validation record documents whichever decision the exercise produces, including a documented no.
Files #
| Path | Size | SHA-256 |
|---|---|---|
files/validation-protocol-healthcare-provider-fraud-detection.pdf |
129,770 bytes | 7bad5c5c62e3935f1c89529a4709be4a772e673ec47cb475be1092025d754473 |
Each file's SHA-256 is listed above. To confirm a download is unmodified: shasum -a 256 filename
Licence: CC BY 4.0