Hospice at mailbox service
Two member entities are registered at UPS Store #4421 mailbox addresses in Los Angeles. Mailbox locations cannot satisfy Medicare hospice conditions of participation under 42 CFR 418.
Every capability from the AVE design page anchored to a runnable scenario. Scenario 1 is live data from the ave-orchestrator. Scenarios 2-8 are baked-in narratives showing how the rest of the catalog operates in production. Click any card to expand. Capability chips inside each card mark which models fired; the gold-highlighted chip is the scenario's anchor capability.
Each scenario card lists the capability chips that fired during that case. The gold-bordered chip is the scenario's anchor capability; surrounding chips are corroborating signals. See the full capability descriptions on the design page.
Each scenario opens to: setup, the AVE pipeline that ran, specific findings (severity-coded), and the action postures the evidence supports. JIL is detection / proof / attestation, not recovery. AVE produces evidence; the customer chooses the action.
14-entity hospice operator network controlled by a single UBO. The integrated case: every primary AVE capability fires together. Live data from the ave-orchestrator.
14-entity hospice operator network controlled by John Doe (UBO). 12 of 14 premises classified as hard-mismatch, including 9 retail strip mall units, 2 UPS Store mailbox addresses, and 1 vacant lot. 12 of 14 entities share 2 of 3 bank accounts with John Doe as signatory. Combined billing: $8,200,000 across 47,000 settlements. Linkage agreement score 0.91. This is what every capability looks like firing on the same case.
| Entity | NPI | Claimed business | Settlements | Flagged $ |
|---|---|---|---|---|
| Final Journey Hospice LLC | 19876543211 |
hospice | 4,050 | $875,000 |
| Eternal Comfort Hospice LLC | 19876543210 |
hospice | 4,000 | $850,000 |
| All Saints Hospice LLC | 19876543209 |
hospice | 3,950 | $825,000 |
| Serenity Hospice Network LLC | 19876543208 |
hospice | 3,900 | $800,000 |
| Trinity End-of-Life Services LLC | 19876543207 |
hospice | 3,850 | $775,000 |
| Heritage Hospice & Home Health LLC | 19876543206 |
hospice | 3,800 | $750,000 |
| Compassionate Care of CA LLC | 19876543205 |
hospice | 3,750 | $725,000 |
| Pacific Coast Hospice Services LLC | 19876543204 |
hospice | 3,700 | $700,000 |
| Golden Valley Hospice LLC | 19876543203 |
hospice | 3,650 | $675,000 |
| Sunset Care Hospice Group LLC | 19876543202 |
hospice | 3,600 | $650,000 |
| XYZ Hospice LLC | 19876543201 |
hospice | 3,550 | $625,000 |
| ABC Hospice LLC | 19876543200 |
hospice | 3,500 | $600,000 |
| Restful Path Hospice LLC | 19876543212 |
hospice | 200 | $50,000 |
| Last Light Hospice LLC | 19876543213 |
hospice | 200 | $50,000 |
Two member entities are registered at UPS Store #4421 mailbox addresses in Los Angeles. Mailbox locations cannot satisfy Medicare hospice conditions of participation under 42 CFR 418.
Network entities billed 287 claims for beneficiaries with service dates after their SSA Death Master File date of death. Posthumous billing total: $94,400.
ABC Hospice LLC and 8 other member entities operate from retail strip mall units 950-1500 sqft. USPS classifies as retail; Google Places shows no medical signage; Street View shows no medical-grade entrance. Inpatient hospice operations require licensed clinical space physically incompatible with these premises.
ABC Hospice LLC billed 1,840 hospice patient-days in Q3 2025, requiring approximately 20 occupied beds. Premise is 1,400 sqft retail unit. Capacity excess factor: 12.4x.
12 of 14 entities in this network share 2 bank accounts (BFP-7a3f, BFP-9b2c) with common signatory John Doe. UBO resolution confirms ownership concentration in John Doe via FinCEN BOI filings. Combined billing: $7.8M across 46,200 claims.
| Pattern | Claims | Dollar total |
|---|---|---|
UPCODED_CPT | 14,000 | $2,520,000 |
PHANTOM_NPI | 8,200 | $1,968,000 |
DECEASED_PATIENT_BILLING | 287 | $94,400 |
Source: Live data from ave-orchestrator /api/v1/public/demo/*. Synthetic engagement seeded from the Section 13 happy-path of the AVE design doc.
One human owns hospices in 13 states billing $227,347,688 to Medicare. To each state Medicaid program it looks like a corporate chain. AVE collapses it to a single network case.
Real anchor pulled from CMS Hospice All Owners (snapshot 2026.04.01). One named individual is registered as a 5%+ owner on 38 distinct Medicare-enrolled hospice provider numbers. Those 38 hospices operate in AZ, CA, CO, IL, IN, KS, MA, MO, OH, PA, TX, VA, WI. Each state Medicaid program sees only the hospices inside its state. The MCOs that administer Medicare Advantage in those states each see only their network. None of the 13 plans, on their own, have line-of-sight into the 13-state pattern. AVE does.
AVE pulls the named individual through CMS PECOS, FinCEN BOI, Delaware/Wyoming/Nevada SOS filings, and (under MCO BAA) the customer's own provider-credentialing records. Builds a single ownership graph spanning 38 entities.
Each entity is independently chartered, has a distinct EIN, and bills under a distinct NPI. AVE's network detection catalog flags this as the 'distributed-shell' signature: same UBO, geographically dispersed, separate billing channels, identical billing-pattern fingerprints.
Across the 38 hospices the per-stay billing is 71% above national median, average length-of-stay is 2.4x national, and General Inpatient (GIP) escalation rate is 0.3% (national: 4.1%). Same fingerprint, all 38 sites.
data.cms.gov/.../all-owners + data.cms.gov/.../medicare-post-acute-care-utilization-hospice. Names redacted on this public demo per legal review.Source: Real: CMS Hospice All Owners + Hospice Utilization PUF (RY 2025 / CY 2023).
Behavioral-health practice billed 18 clock hours of telehealth per credentialed provider per day, every day, including federal holidays. AVE volume capacity model: physically impossible.
Single behavioral-health LLC bills 6 NPIs against an MCO under telehealth modifiers (95, GT). AVE retroactive scan ingests 12 months of remittance lines. Each NPI shows continuous billing across full calendar months including weekends, Christmas Day, and Thanksgiving.
AVE volume-capacity model converts each remittance line to a clock-hour estimate using CPT-to-time conversion tables (MUE/CCI). Per-NPI median: 14.2 hours/day; 90th percentile: 21.6 hours/day. National benchmark for full-time licensed behavioral health: 6.5 billable hours/day.
AVE pattern catalog match: BH-PHANTOM-95. Signature is high CPT 90837 frequency (60-min sessions billed end-to-end), zero CPT 90834 (45-min) variance, zero no-show codes, and zero IP-session diversity in the EHR audit log.
Premise check: clinic operates from a 850 sqft Class-B office unit (USPS classification: business). 6 simultaneous telehealth sessions would require 6 isolated rooms; premise has 2. Login telemetry (under MCO BAA): all 6 NPIs share the same originating IP for 78% of sessions.
BH-PHANTOM-95 from AVE catalog. Pattern characteristics: 100% match on 5 of 5 axes (CPT mix, no-show absence, IP collapse, hour math, premise constraint).BH-PHANTOM-95. IP-collapse correlation report.
Source: Synthetic, modeled on documented behavioral-health telehealth fraud patterns 2022-2024.
DME supplier billed 47 customized power wheelchairs per month from a 1,200 sqft strip-mall unit. USPS classifies retail; Street View shows nail salon on left, taqueria on right; no loading dock visible.
DME supplier billing under HCPCS K0856 (Group 3 power wheelchair, 14"-16" seat). MCO settlement-routing system flagged the claims-density per NPI for retroactive review.
USPS street-address API: classification retail. Google Places business listing: "Sun Discount Medical" (no medical signage in Street View imagery). Premise type: 1,200 sqft commercial retail unit, single front entrance, no roll-up door, no loading dock.
Claimed business: power-wheelchair distributor. Compatibility rule from AVE catalog: DME-PWR-WHEELCHAIR-001 requires (a) loading dock or roll-up door, (b) 200+ sqft per chair for assembly clearance, (c) at least one rear delivery access. None of (a)/(b)/(c) satisfied. Verdict: hard mismatch.
47 chairs/month at the typical Group 3 footprint (35 sqft/chair assembled, 80 sqft/chair with packaging) requires 1,640 sqft of staging at minimum. Premise total floor area: 1,200 sqft. Cannot stage even one month of inventory inside the unit.
incompatible. The unit cannot physically house the operation it bills against.DME-DROPSHIP with confidence score.
Source: Synthetic, composite of OIG fraud alerts 2018-2024 on Group 3 power wheelchair fraud.
Provider on the OIG LEIE List of Excluded Individuals/Entities (2019 mail-fraud case) reappears as a managing member of a new home-health LLC under a name spelled with one letter different. AVE entity resolution catches it.
Home-health LLC bills MCO across 412 claims. AVE Tier 1 retroactive scan runs the 'Magnolia Home Care, LLC' principals through OIG LEIE, SAM.gov debarments, and state Medicaid exclusion rosters.
Managing member listed in NV SOS as 'Roberta J. McLeansville'. AVE entity-resolution model normalizes name (phonetic + Levenshtein + soundex + DOB hash + address corroboration). Closest match in OIG LEIE: 'Roberta J. McClansville' (single letter difference, exclusion 2019, 5-year mail-fraud bar).
Same DOB (1971-08-14). Same Las Vegas zip code on initial filings. Same prior employer (Sunset Care Group, also OIG-excluded). Three corroborating signals on a fuzzy name match move the verdict from probable to confirmed.
OIG bar period: 2019-12-01 through 2024-12-01. Claims billed on 2025-01-04 onward (35 days post-bar-end). However: 'reverse FCA' liability potentially attaches to any claim where the principal made an affirmative misrepresentation about prior debarment on the credentialing form.
Source: Synthetic, modeled on documented re-entry-after-exclusion patterns from OIG enforcement reports.
Six hospices share the same back-office. Average length-of-stay 380 days (national: 124). General Inpatient (GIP) escalation: 0.4% (national: 4.1%). Pattern matches catalog code <code>HOSP-LOS-3X</code>.
AVE Tier 1 retroactive scan over 18 months of MCO hospice payments. Six providers cluster on three independently scored anomaly axes: average LOS, GIP-escalation rate, and routine-home-care percentage.
AVE matches the cluster's billing fingerprint to catalog code HOSP-LOS-3X with confidence 0.94. Pattern definition: average length-of-stay >= 280 days, GIP rate <= 1.0%, routine-home-care percentage >= 90%, terminal-prognosis recertification compliance < 80%.
AVE bank fingerprinting (separate capability) shows the 6 hospices share 1 of 3 bank accounts. Address graph: same back-office street address on Article-of-Organization filings. Phone: same 2 numbers across 6 NPIs in the credentialing record. Verdict: shared back-office, coordinated billing.
Medicare hospice rules require physician recertification at days 90, 180, 240, and every 60 days thereafter. AVE pulls recert-document timestamps from the customer's clinical-document store: 38% of episodes lack a timely day-180 recertification, 61% lack day-240.
HOSP-LOS-3X. Recertification-compliance audit. Network-membership evidence package.
Source: Synthetic, modeled on documented OIG hospice-LOS audit findings 2021-2024.
Behavioral-health LLC billed 200+ adult therapy sessions per month from a Texas address. State-licensing record: same address holds an active children's daycare license. Two non-overlapping regulatory regimes for the same square footage.
MCO behavioral-health network. Single LLC enrolled at a 2,200 sqft single-family-home address in suburban Dallas. AVE Tier 1 scan classifies premise via county GIS + Texas state licensing database.
Address resolves to a single-family residence per county GIS. County permit history shows a Class-A daycare conversion permit issued 2019 to a different LLC. Texas Health and Human Services license database: active children's daycare license at this address, same physical building.
Claimed billing entity operates as licensed-clinical-social-worker private practice. Texas LCSW operating-from-licensed-daycare-premises: not a recognized regulatory configuration. AVE catalog match: BH-PREMISE-CONFLICT.
Daycare licensed hours: 06:30-18:30 weekdays. AVE-extracted session timestamps: 73% of billed sessions fall inside the daycare's licensed operating hours. Premise cannot lawfully be both at the same time.
Source: Synthetic, modeled on documented dual-licensed-premise mismatches in behavioral-health enforcement.
AVE HMAC-fingerprints routing+account on every disbursement. 14 home-health LLCs claimed independent. 11 of 14 share 2 fingerprints. GLBA-safe correlation. Raw account numbers never persisted.
MCO home-health network. Each provider self-attested as financially independent at credentialing. AVE Tier 1 ingest receives one disbursement record per claim; the disbursement leg carries the routing and account number for the recipient ACH/wire.
Each disbursement's routing+account is HMAC-SHA-256-hashed against an engagement-scoped key. Raw routing and account values are zeroed in memory immediately after hashing. Only the fingerprint is persisted. This is the GLBA-compliant correlation primitive.
AVE clusters disbursements by fingerprint. Across the 14 LLCs there are 14 distinct fingerprints, but only 2 fingerprints account for 88% of disbursement dollars. 11 of 14 LLCs route into the 2 dominant fingerprints.
AVE pulls each LLC's bank-signatory record from the credentialing file. Same individual is signatory on the 2 dominant fingerprints. UBO resolution confirms: 11 of 14 'independent' providers route into accounts controlled by one human.
Source: Synthetic, modeled on documented home-health-network shell patterns and AVE's GLBA-compliant fingerprinting design.
Tier 1 retroactive scan starts the 180-day investigation safe harbor. AVE Tier 2 produces the documented good-faith investigation. Pre-Settlement prevents the exposure from arising next quarter.
Read the AVE design See the public-data POC ($165M flagged) 20-slide MCO deck Open the credentialed workspace
Public demo. Synthetic data unless otherwise noted. No PHI. Names redacted on real-data scenarios pending counsel review of public-record-naming posture. The credentialed workspace at retail.jilsovereign.com/ave/demo runs against engagement-scoped data under BAA.