Palantir Technologies Inc.

Diane Wu

Rahul Kumar Agarwal

Di Wu

Parvathy Menon

John Kenneth Garrod

Ankit Shankar

Daniel Erenrich

Allen Cai

Geoff Stowe

Eli Bingham

Jacob Scott

Zachary Bush

Feridun Arda Kara

Brian Ngo

Anirvan Mukherjee

Andrew Ash

Greg Martin

Engin Ural

Sean Kelley

William Dwyer

Winnie Chai

Ted Mabrey

Drausin Wulsin

Gilad Gray

Samir Talwar

Holt Wilkins

Greg Cohan

Chris Dorsey

Spencer Stamats

Dennis Kwon

Chris Lewis

Asli Ozyar

Mike Reilly

Matt Sills

William Seaton

Joyce Yu-Hsin Chen

Gokul Subramanian

Bar Kaya

Patricio Jones Velez

Yu-Hsin Joyce Chen

Baris Kaya

P J Valez

Pj Valez

Systems and methods are described for automatically processing data stored in one or more databases using machine learning to detect entities (such as health care providers, health care plan members, patients, pharmacies, and so forth) associated with health care claims that are suspected of fraudulent, wasteful, and/or abusive activity. The techniques may further or alternatively involve generating and presenting, for a set of suspected entities, natural language explanatory information explaining how and/or why each of the respective suspected entities is considered to be suspected of fraudulent, wasteful, and/or abusive activity. Feedback provided by fraud analysts and/or other subject matter experts in the misuse detection space is used to facilitate misuse detection and misuse detection presentation.

Fraud lead detection system for efficiently processing database-stored data and automatically generating natural language explanatory information of system results for display in interactive user interfaces

In an embodiment, a computer-implemented method comprises, in response to receiving lead data identifying an entity associated with a health care claim relating to suspected fraud, determining one or more data sources that were used to identify the entity or the suspected fraud; determining a subset of a plurality of data display elements, based on the determined one or more data sources, wherein each of the plurality of data display elements is configured to cause displaying health care claims data associated with the entity in a designated format; automatically obtaining, from a data repository, specific health care claims data associated with the entity for each of the plurality of data display elements in the subset; generating a lead summary report associated with the entity using a report template, the subset, and the obtained specific health care claims data.

Medical claims lead summary report generation

Systems and methods are provided for analyzing entity performance. In one implementation, a method is provided that includes recognizing an identifier associated with an entity and accessing a data structure comprising information associated with a plurality of interactions. The method also comprises identifying one or more interactions of the plurality of interactions based on the recognized identifier. The method further comprises processing the information of the identified interactions to analyze a performance of the entity and providing the processed information to display the performance of the entity on a user interface.

Methods and systems for analyzing entity performance

Systems and methods are provided for analyzing entity performance. In one implementation, a method is provided that includes receiving a request with one or more filter selections and accessing a data structure comprising a plurality of categories of information showing interactions associated with multiple entities. The method also comprises identifying a set of categories of the plurality of categories within the data structure based on the one or more filter selections. The method further comprises processing the information of the identified categories to analyze a performance of one or more entities of the multiple entities in accordance with the one or more filter selections and providing the processed information to display the performance of the one or more entities on a user interface.

Systems and methods are provided for analyzing entity performance. In one implementation, a method is provided that includes accessing a data structure comprising a plurality of interactions associated with multiple entities. The method also includes evaluating one or more interactions of the plurality of interactions associated with a consuming entity of the multiple entities. The method further includes determining whether the one or more interactions associated with the consuming entity comprise an identified location information of the consuming entity.

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Palo Alto, CA, United States of America

Diane Wu