RFS: Fraud in Public Healthcare Programs: Developing Fraud Detection Models with Linked Data

On June 16, 2025, ATI published the following Request for Solutions (RFS): Fraud in Public Healthcare Programs: Developing Fraud Detection Models with Linked Data.

The submission deadline for the project was July 8, 2025, at 5 PM ET. Membership in ADC is not required for submission. However, if chosen, the selected organization must join ADC.

Be sure to explore our Consortia Member Training for helpful resources and support tools as your prepare your proposal.

Fraud in Public Healthcare Programs: Developing Fraud Detection Models with Linked Data

Fraud detection across public programs is hampered by critical data being scattered among disparate systems, formats and agencies (see 2024 GAO report). This fragmentation creates significant information gaps that hinder the government’s ability to identify which new and expanding programs are most vulnerable to fraud. This challenge is compounded by limited data sharing and interoperability across oversight bodies, making it difficult to assemble a comprehensive view of fraud. However, by standardizing and linking unstructured, open-sourced, and under-utilized data, agencies can detect emerging patterns of fraud more quickly and build timely evidence.

This Request for Solutions (RFS) seeks to show how existing federal and state databases could be used to produce new data products that augment understanding of fraud trends and to create new risk-scoring tools that can be leveraged by the Department of Justice’s (DOJ) Fraud Section’s Healthcare Fraud Unit and others. The objectives of this project are to demonstrate the feasibility and value of using the National Secure Data Service (NSDS) to combine data from federal, state, and other sources to: (a) develop a new risk-scoring model to detect the magnitude of fraud against federally-funded public healthcare programs; (b) identify risk factors and vulnerabilities for healthcare fraud; and (c) pilot the use of new technologies that can lend efficiencies to currently underutilized or previously unlinked data sources.

A Teaming Speed Networking Event was also held on June 19 at 1 PM ET. To access the presentation slides and attendee lists from previous Speed Networking events, please log in to the Member Only Site.

Request for Solutions