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LegalRealist AI

Open Lab Focused on Applying AI to Legal Practice

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I Built the Backtest: What Excluded Medicare Providers Look Like Before They Get Caught

The previous post described a Medicare fraud backtest nobody had built. I built it. 289 excluded providers across 41 states, matched to pre-exclusion billing data, compared against 3.39 million peers. Thirteen of fifteen features showed statistically significant differences — and the behavioral fingerprint is consistent enough to predict fraud in providers who were never excluded.