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Documentation Index

Fetch the complete documentation index at: https://docs.encoreos.io/llms.txt

Use this file to discover all available pages before exploring further.

This page surfaces automatically detected billing anomalies for compliance review and is reached at /pm/fraud-abuse.

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Overview

The Fraud & Abuse Flags page displays billing anomalies detected by automated checks run against pm_claims. The current shipped implementation scans the most recent 500 claims for the organization and identifies potential duplicates: claims with the same patient, service date, and total charge amount. Each flagged item shows the flag type, entity type, identifier (claim number), date, and a plain-text summary. The page is read-only; no action buttons appear on the list. An empty state (“No flagged items”) displays when no anomalies are found.

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Who it’s for

Requires permission: PM_PERMISSIONS.COMPLIANCE_REPORTS (pm.compliance.reports). Users without this permission see a destructive alert stating they do not have access.

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Before you start

  • You must hold the pm.compliance.reports permission.
  • Flag checks run against claims already recorded in the system; claims must exist before flags can be generated.

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Steps

1

Open Fraud & Abuse Flags

Navigate to Practice Management → Fraud & Abuse Flags or go directly to /pm/fraud-abuse. The page runs the automated duplicate check on load.
2

Review the flags table

Each row shows: Flag Type badge (e.g., “Duplicate”), Entity (e.g., “claim”), Identifier (claim number or ID in monospace), Date, and Summary describing the potential issue.
3

Act on flagged items

Use the claim identifier to locate the full claim record at /pm/claims/:claimId for manual review.

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Key concepts

Three flag type labels exist: Duplicate (duplicate), Outlier (outlier), and Unusual Pattern (unusual_pattern). Only duplicate detection is implemented in the current hook; the other types are defined but not yet generated.
The check queries the 500 most recent claims ordered by created_at descending, then groups by patient_id + service_date_from + total_charge. The second occurrence of any combination is flagged as a potential duplicate.
When no flags are detected, the page shows “No flagged items” with the note “Checks run on schedule or on demand.”

Practice Management

Overview of the Practice Management core.

Governance & parity

Documentation coverage and governance.
This page documents shipped product behavior. It is not medical, legal, or billing advice. Verify against your organization’s policies and applicable regulations before using it for clinical, compliance, or billing decisions. Protected health information (PHI) shown in the product is governed by your tenant’s access controls and is never exposed in this documentation.
  • src/routes/pm.tsx
  • src/cores/pm/pages/FraudAbuseFlagsPage.tsx
  • src/cores/pm/hooks/useFraudAbuseFlags.ts
  • src/cores/pm/types/audit-compliance.ts