Catch fraud with evidence, not guesswork.
Papaya screens every claim for fraud, waste & abuse as it flows through the pipeline — six independent factors, each flag backed by data from the claim itself. Detect over-billing, collusion, and manipulated documents at scale, and hand your SIU team investigation-ready insight.
Flags raised
0
this month · all evidence-backed
True-positive rate
0%
Upcoding — billing factor
CLM-2026-04892 · procedure billed 2 tiers above documented severity vs. MOH benchmark
0
Detection factors
0
Hallucinated flags
0
Max flags / claim
<0s
In-pipeline
Six-factor analysis
Fraud shows up in six places. We watch all of them.
Each factor runs independently against the claim, the policy, and 60,000+ medical reference records — then corroborates the others before a flag is raised.
Timing
Policy-to-claim gaps, claim frequency spikes, and coverage-change timing that precede a loss.
Clinical
Diagnosis–treatment mismatches, medically implausible pairings, and contradictions against clinical pathways.
Billing
Duplicate billing, upcoding, unbundling, and prices out of line with market and MOH benchmarks.
Provider
Provider concentration risk, location mismatches, and network patterns that signal collusion.
Document
Image forensics for tampering, inconsistent dates, and reused or manipulated receipts.
Policy
Benefit-maximization behaviour and coverage exploitation across the policy lifecycle.
How it works
Built into the claim, not bolted on after.
Screened in the pipeline
FWA runs in parallel with assessment on every claim — not a separate batch job, not a sample. Nothing skips it.
Every flag carries evidence
Each flag cites the exact data from the claim that raised it. If there's no evidence, there's no flag — zero hallucination by design.
Capped at eight, ranked
A maximum of eight flags per claim, prioritized by severity. Quality over noise, so investigators trust the queue.
Routed to your SIU
Suspicious claims escalate to your investigation team with the full evidence trail attached — clean claims settle automatically.
Evidence over noise
We'd rather miss a flag than fabricate one.
Most fraud tools bury investigators in low-confidence alerts. Papaya does the opposite: every flag is traceable to specific evidence in the claim, capped at eight per claim, and ranked. Your SIU team spends time on real cases — not chasing ghosts.
See what you're currently missing.
Run Papaya FWA against a sample of your claims and see the flags — with evidence — in minutes.