Stop letting fraudulent providers slip through.
Catch them before they bill.
AI-powered screening that cross-references every provider against exclusion lists, enrollment records, and behavioral signals — so bad actors never make it into your network.
Built for
The problem
lost annually to healthcare fraud in the U.S. alone. Most of it from providers who were never properly screened before entering a network.
of fraudulent providers pass basic exclusion-list checks. Name matching and OIG lookups miss shell entities, address clustering, and enrollment patterns that signal fraud.
average time for a compliance analyst to manually investigate a single flagged provider. Most teams have hundreds in their queue at any given time.
Current tools check names against lists. That's not screening—that's checkbox compliance. The providers committing fraud know exactly how to pass those checks.
See what Synexi surfaces in seconds
A real-time provider risk profile — enrollment age, address clustering, specialty mismatches, license actions, and ownership changes — scored, explained, and ready for action.
Synexi
Shell hospice registered 122 days ago at a shared address. No website, no footprint. 12 other entities at the same location. Classic address concentration pattern used to spread billing across shells.
Brief generated
Built for depth, not just speed
Every provider is scored against 9 distinct risk signals in under 2 seconds — no manual triage, no guesswork.
Screens every provider. Catches what keyword matching misses.
Other tools match names against exclusion lists and call it done. Synexi cross-references enrollment age, address clustering, specialty alignment, licensure history, ownership changes, and web presence. The shell entity registered last month at a shared address in Dallas—other software won't flag it. Synexi will.
Synexi Risk Engine
8/8 checks
Every flag has a reason. Every score is defensible.
Compliance teams can't act on black-box scores. Synexi surfaces every signal that contributed to a risk determination—with weighted evidence, severity markers, and audit-ready documentation. When regulators ask why you flagged a provider, you have the answer.
Enrollment age is 122 days, below the 12-month threshold.
Location shared by 12 provider entities in the directory.
No validated website or business footprint found.
Stated specialty conflicts with referral pattern signals.
What a compliance analyst would write. Instantly.
You're reviewing a flagged provider at 10pm trying to figure out if this is a real risk or a false positive. Synexi's AI copilot writes the investigation brief, suggests interventions, and frames the questions your team should be asking—so you can focus on the decision, not the write-up.
Synexi Copilot
Silverline Comfort Hospice LLC currently sits at a 100/100 risk score with a high risk recommendation. The primary concerns are recent enrollment (122 days), high address concentration (12 entities at same location), and no verified web presence.
1. Pend referral or onboarding until identity and licensing checks complete.
2. Assign to compliance for documented review with supporting evidence.
3. Capture decision rationale for defensible audit trail.
Is the shared address operationally legitimate or part of a shell network? Can we independently verify the provider's active service footprint?
We go deep
When Synexi finds a threat, we do not stop at the alert. We research it like a senior healthcare fraud analyst would, except in seconds. Pull enrollment history. Check shared addresses. Map linked entities. Review ownership churn. Validate web footprint. Compare specialty alignment. Draft the compliance brief. All of it, automatically, before your team asks.
Our Process
Every provider in your network gets run through NPPES enrollment records, OIG exclusion lists, address registries, licensure databases, taxonomy codes, and ownership filings. We map your entire exposure automatically. Within seconds, we know which providers could hurt you, which ones are clean, and which ones are designed to look clean. No keyword matching. No manual review. Just signal.
When we find a threat, we don't just flag it. We research it like a senior compliance analyst would—except in seconds. Pull the enrollment history. Check the address concentration. Map the shared entities. Find the ownership changes. Compare the specialty codes against referral patterns. All of it—automatically, before you ask.
NPI exact-match on federal exclusion list
14 providers registered at the same suite
6 specialty codes across one NPI
No updates in 4+ years
Your compliance analyst shouldn't spend 45 minutes writing up what we can produce in 5 seconds. We generate investigation briefs, suggest interventions, and frame the questions your team should be asking. When regulators come knocking, you have a defensible audit trail. When leadership asks what you caught, you have the receipts.
The old way vs. Synexi.
Others
Their software matches names against OIG and SAM exclusion lists and calls it done. Misses the shell entity registered last month. Misses the address shared by 12 providers. Misses the hospice with no website, no phone, and an ownership change every 90 days. Not trained on how any of this actually works.
Others
Their AI gives you a "risk score" with no explanation. A black box number that your compliance team can't defend to regulators, can't explain to leadership, and can't use to make an actual decision. When CMS asks why you approved a provider, you shrug.
Others
They make you sit through onboarding calls. Spend weeks learning their dashboard. Adapt your workflow to fit their product. Pay six figures a year for software you can't use, so you default back to spreadsheets and phone calls anyway.
Synexi
We mapped the real signals of healthcare fraud. Address concentration. Enrollment velocity. Ownership churn. Web presence gaps. The stuff that's not on any exclusion list—but every experienced investigator knows to look for. We catch the providers that other software waves through.
Synexi
We don't give you a number and walk away. We give you every flag, every signal weight, every piece of evidence that contributed to the score. When regulators ask why you flagged a provider, you hand them the brief. When leadership asks what you caught, you show them the receipts.
Synexi
Our team built this because we lived the problem. We learn how your team works and build around you—not the other way around. No wasted months. Operational in days. And if something goes wrong, you get the founder's number. Problems don't wait in line.
What the platform actually does
FCA Case Acceleration
From tip to complaint-pack in hours, not months. Synexi structures the full FCA workflow—intake, evidence linking, allegation mapping, and legal review—so your team moves at the speed of the fraud.
- Tip intake + evidence linking + allegation mapping
- AI-generated draft brief and complaint-pack support
- Manual legal review gate before any action is taken
Investigation-Ready Risk Reports
Not just a score—a report your compliance team can actually use. Every output is structured for decision-making: sourced evidence, analyst-grade interpretation, and confidence-level transparency.
- Risk score + key flags + source-backed evidence
- Analyst-style interpretation + recommended actions
- Confidence score + low-confidence warnings
Batch Screening + Network Clusters
Screen networks, not just single providers. Upload an entire roster and get back prioritized risk profiles with cluster detection—shared addresses, shared officials, and linked entities surfaced automatically.
- CSV bulk screening for provider rosters
- Shared-address / shared-official cluster detection
- Top-risk prioritization + one-click case creation
Human-Approved Automation
Automation where it helps, human control where it matters. Every escalation path requires analyst sign-off. Every decision is versioned, diffable, and audit-ready.
- Draft → analyst review → approved-for-action workflow
- Required reviewer notes for key escalations
- Version history, diff view, and complete audit trail
Built-in accountability
Continuous measurement of scoring accuracy and operational controls.
Enterprise security, built in from day one.
Your provider data is sensitive. We treat it that way—with infrastructure-level protections, not afterthoughts.
Rate-limited access
Login, registration, and API requests are rate-limited per IP. Brute force attempts are automatically blocked and logged with IP and user agent for forensics.
Hashed credentials
Passwords are derived with PBKDF2-SHA512 at 120,000 iterations with per-user salts. Session tokens are SHA-256 hashed—never stored in plaintext, never reversible. Constant-time comparison prevents timing attacks.
Tenant isolation
Every database query is scoped to the authenticated user. Request bodies are size-limited and validated. Content Security Policy and strict transport security are enforced on every response.
Role-based access
Granular permissions for every team member. Analysts, investigators, and admins each see only what they need.
Audit-ready logging
Every action timestamped and attributable. When regulators ask questions, you have a complete, defensible trail.
Session security
Sessions auto-expire after 7 days, with max 5 concurrent sessions per user. Password changes invalidate all other sessions. Tokens are hashed, cookies are HttpOnly + Secure + SameSite.