Data-Miners

DOJ's new FOCUS initiative wants better data-driven fraud cases. But it keeps its two best enforcement channels — whistleblower tips and data miner analytics — in separate silos. The real opportunity is connecting them.

Public PPP data can produce enforcement-relevant anomaly maps. An open-source fraud-scoring system, run against the SBA PPP dataset, surfaced lender and geographic concentrations that overlap with known enforcement patterns — while also showing why public data cannot prove fraud by itself.

The PPP fraud pipeline worked because the SBA released unusually inspectable data. Medicare's public data is fragmented, de-identified, and missing the features detection needs. Here's what exists on GitHub, where it falls short, and what CMS would need to release to make outside healthcare-fraud analysis more practical.