Healthcare Provider Billing for Deceased Patients
Dr. Rajesh Doyle (Doyle Medical Clinic) has submitted health insurance claims for 3 patients who were deceased at the time of claimed services. Total fraudulent claims: TTD 45,000 over the past 6 months.
CriticalBilling Anomaly

Status

New

Source Ministry

Ministry of Health

Created

2/15/2025, 2:00:00 PM

Assigned To

Dr. Nisha Bhakti

Risk Score

82

Entity

Dr. Rajesh Doyle

AI Analysis

AI Confidence: 91% - High

Claims audit cross-referencing Registrar General death records identified 3 patients with service dates after their registered death dates. Patient 1: claimed 2024-12-15 (died 2024-10-02). Patient 2: claimed 2025-01-20 (died 2024-09-15). Patient 3: claimed 2025-02-01 (died 2024-11-30). Dr. Doyle is a sibling of Anthony Doyle, who appears in multiple other fraud alerts.

Related Entities
Entities involved in this alert

Dr. Rajesh Doyle

citizen

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Standard Investigation PlaybookGuided Investigation
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Step 1

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Data Source: Source System
Step 2

Review related records

Check for corroborating information

Data Source: Multiple
Step 3

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Identify connected entities and patterns

Data Source: Network Analysis
Step 4

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Data Source: Investigation Notes

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Risk Score

Source: AI Risk Engine

82/100

Entity Type

Source: Entity Registry

citizen

Alert Category

Source: Alert System

Billing Anomaly
Estimated time saved:25-35 minutesper investigation with auto-enrichment
Investigation Notes
Add notes and observations about this alert
Sarah Mohammed2 hours ago

Initial review completed. Confirmed death certificate filed on Jan 10, 2024. Pension payments continued through current month. Escalating for recovery action.

System5 hours ago

Alert automatically generated by cross-reference between Registrar General death records and NIS active benefit payments.

Activity Timeline

Status changed to Investigating

by Sarah Mohammed

2 hours ago

Alert acknowledged

by Sarah Mohammed

3 hours ago

Alert assigned to Sarah Mohammed

by System

5 hours ago

Alert created

by System

5 hours ago