Methodology and measured precision
Every number on this page is measured on labeled synthetic ground truth. None of it is field performance. Field performance requires a calibration pilot on the customer's own data, and until that pilot has run, we will not quote one.
The full rule table
27 of 28 rules have measured
precision. The table is sorted by precision, and the low rows are
published on purpose. A rule that is not ready is labeled, not hidden.
Rules version: 2026-07-22-w4-sparse-referral.
| Rule | Precision measured on synthetic ground truth | Labeled cases | True positives | False positives |
|---|---|---|---|---|
| New provider anomaly | 1.00 synthetic ground truth | 40 | 30 | 0 |
| Impossible day hours | 1.00 synthetic ground truth | 388 | 6 | 0 |
| Deceased patient | 1.00 synthetic ground truth | 315 | 285 | 0 |
| Procedure frequency outlier | 1.00 synthetic ground truth | 340 | 1 | 0 |
| Cci unbundling | 1.00 synthetic ground truth | 24 | 8 | 0 |
| Referral loop | 1.00 synthetic ground truth | 1,046 | 4 | 0 |
| Consent defect | 1.00 synthetic ground truth | 48,854 | 3,820 | 0 |
| Note provenance | 1.00 synthetic ground truth | 800 | 60 | 0 |
| Rpm coherence | 1.00 synthetic ground truth | 400 | 80 | 0 |
| Authority scope | 1.00 synthetic ground truth | 100 | 66 | 0 |
| Udt mill | 1.00 synthetic ground truth | 210 | 180 | 0 |
| Hcc inflation | 1.00 synthetic ground truth | 150 | 30 | 0 |
| Dme mismatch | 1.00 synthetic ground truth | 20 | 10 | 0 |
| Wound care hospice | 1.00 synthetic ground truth | 16 | 8 | 0 |
| Document fingerprint | 1.00 synthetic ground truth | 40 | 10 | 0 |
| Coercion escalate | 1.00 synthetic ground truth | 40 | 15 | 0 |
| Telemetry liveness | 1.00 synthetic ground truth | 325 | 116 | 0 |
| Device signature index | 1.00 synthetic ground truth | 325 | 109 | 0 |
| Missing pathology | 0.98 synthetic ground truth | 312 | 103 | 2 |
| Pathway expectation | 0.80 synthetic ground truth | 282 | 33 | 8 |
| Upcoding distribution | 0.75 synthetic ground truth | 2,974 | 3 | 1 |
| Cleaned scheme | 0.73 synthetic ground truth | 290 | 80 | 30 |
| Panel overutilization | 0.50 synthetic ground truth | 116 | 1 | 1 |
| Missing anesthesia | 0.48 synthetic ground truth | 3,646 | 1,219 | 1,303 |
| Missing facility | 0.33 synthetic ground truth | 1,352 | 670 | 1,360 |
| Pos mismatch | 0.15 synthetic ground truth | 154 | 16 | 89 |
| Missing post op pt | 0.10 synthetic ground truth | 1,970 | 267 | 2,477 |
Field performance is different from synthetic performance. Before any production use we run a calibration pilot on the customer's own data and report those numbers instead.
How to read these numbers
Precision answers one question: when this rule flags a claim, how often is the claim actually bad? A precision of 1.00 means every flag in the labeled set was a true positive. A precision of 0.48 means roughly half were not, and that rule is not ready to act on alone. We publish both because a buyer who only ever sees perfect numbers is being managed, not informed.
The corpus
The test corpus contains 521,997 synthetic claims across 2,000 synthetic providers. It is generated from a seeded, deterministic generator, which makes it byte-reproducible: the same code and the same seed produce the same corpus, byte for byte. Fraud archetypes are injected with known labels, which is what makes ground truth possible.
It contains zero PHI. No real patients, no real providers, no production claims data. Every name, identifier, and record in it is synthetic.
What we do not verify
- Medical necessity. The rules check whether records contradict each other, not whether care was clinically warranted.
- Clinical accuracy of readings. We verify that readings exist, cohere, and match the device on file. We do not verify that a blood pressure value was medically correct.
Every bundle repeats these limits in its own gap list. An artifact that overstates what it checked would not survive expert scrutiny, and it should not.