Medicare DME billing fraud
medicare-dme-billing-fraud
What this tier means
High-confidence threat indicator — phishing, impersonation, BEC, or scam pattern. Strong contributor to the trash decision.
How Gorganizer detects this
Email targeting Medicare beneficiaries with unsolicited offers of "free" durable medical equipment — knee braces, back braces, CPAP supplies, diabetes test strips — collecting Medicare ID and date of birth to bill Medicare fraudulently. CMS OIG: DME fraud costs Medicare $3B+ annually; brace fraud alone resulted in $1.2B in fraudulent claims in 2024.
False-positive guard
Every signal in Gorganizer feeds a multi-module score — never a sole verdict. This is a threat-tier signal — it adds a strong contribution to the trash score. The full pipeline still requires convergence across multiple modules + a margin over the safety floor before deletion happens, and Gmail's trash (30-day recovery) is always used — never permanent delete.
About the scoring engine
Gorganizer's scoring engine emits 2,143+ signals across six modules — headers, sender, subject, body, attachments, and structural metadata. Every email is scored by every module independently; the final verdict requires multiple modules to agree and the trash score to beat the safety floor by a margin.
Sacred safety guards — never delete starred emails, replies, calendar invites, receipts/invoices, or attachments — apply unconditionally regardless of any signal.
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