Solutions / Carpe LTC
Find the Fraud in Your Long-Term Care Book
Catch the rings your investigators are already chasing, sooner. With Carpe LTC, the cases that used to die in the pipeline close and the losses stop spreading before another claim is paid.
See the Real Operator
Catch the Caregivers Others Miss
Find the Rings in Your Book
Investigators Closing Cases
Denials That Hold Up
The Challenge
The Same Bad Operators, Hidden Across Dozens of LLCs
One operator runs facility after facility under a fresh LLC name each time, moving money to companies that operator secretly owns, thinning staff below what residents need, and stacking harm citations across the portfolio. Your claims operation pays into the pattern blind, because the evidence sits scattered across a dozen government datasets no one has time to stitch together.
The Carpe LTC Response
Catch the Operator Before More Claims Land
Carpe LTC names the real operator behind every facility on your book and lights that operator up across eight independent government datasets at once. The pattern your investigators have been chasing surfaces on the page with provenance on every signal, so the cases your team is already working close sooner and the ones they would have missed land in the worklist before another claim is paid.
From a Suspect Facility to a Defensible Denial
Every flagged operator and every flagged claim runs through the same five stages. Your investigator sees the source behind every signal, so the case file is replayable end to end and stands up in front of a regulator or reinsurer.
Stage 01
Find the Real Operator
Carpe LTC names the operator hiding behind every nursing facility on your book, including the LLC web. The 200-home blob splits into the real sub-operators driving the losses, so your investigators stop chasing facilities and start chasing the actor behind them.
Stage 02
Score the Risk
Every operator gets scored against the eight patterns that precede fraud. Where money or exclusions are in play, a Confirmed-or-Probable grade tells your team exactly how much weight to put on each flag, so nothing in the case file is overstated.
Stage 03
Spot Patterns in Your Book
Inside your own claims, four detectors catch the rings your SIU team is already chasing and the ones they have not seen yet. Impossible-day double-billing, provider clusters around a hidden operator, shared-identity rings, and household concentrations sitting behind an improbable number of claims.
Stage 04
Investigator Builds the Case
Your SIU manager opens a ranked worklist and assigns it. Investigators walk cited evidence and run guided investigation steps that produce findings traceable to a government source, never the kind of unsupported claim that gets a denial overturned.
Stage 05
Deliver the Evidence Package
Every disposition produces the prosecutor-ready PDF and ROI panel that makes a denial stick, the same source-cited file your reinsurer or regulator would walk into the room with. The cases that used to die in the pipeline close.
State Spotlights
What Two Real States Might Say About Your Book
Florida
27%
of Florida facilities
Carpe LTC found that more than one in four homes in Florida is running in severe regulatory failure today. Every Florida claim on your book has a one-in-four chance of routing to a facility that should not be open.
Texas
64%
of Texas facilities
Carpe LTC found that nearly two out of every three homes in Texas is running in severe regulatory failure. A claims operation paying into the Texas market without knowing which homes sit in that two-thirds is paying out blind.
Every Operator on Your Book, Scored Before the Next Claim Hits
One engine drives all of it: every nursing facility on your book ranked by the operator behind it, scored across eight independent government datasets, with every flag traced back to the official record. Below are the eight patterns that decide where an operator lands in the worklist.
Operator Resolution
The same bad actor running dozens of homes under fresh LLC names.
Ownership Churn
Operators reincorporating to shake a track record of harm and fines.
Financial Distress
Margin collapse and insolvency that almost always precede fraud.
Related-Party Money-to-Self
Dollars routed to companies the operator secretly owns.
Exclusion Flags
Owners already on the federal exclusion list.
Co-Location
Hidden operators stacked at the same address.
Ghost-Staffing
Staffing below what payroll reports or resident acuity demands.
Resident Harm
Actual-harm and immediate-jeopardy citations regulators have already recorded.
Why Carpe LTC
The LTC investigator workbench is a new category. Below is how Carpe LTC stacks up against the fraud platforms your team may already be running.
| Capability | Carpe LTC | Generic Fraud Platforms |
|---|---|---|
| Names the real operator | Every facility resolves to the actor hiding behind the LLC web, so your investigators chase the operator, not a single shell. | Generic fraud models with LTC stamped on the side. |
| Live on day one | Goes live on federal data alone. No data-use agreement to negotiate, no claims feed to wait on. | Sits idle until your carrier loads claims into a shared pool first. |
| Finds rings in your own book | Detectors run on your claims alone, so the rings inside your book surface without sharing data outward. | Network model only lights up if you share your data with the consortium. |
| Catches caregivers without an NPI | Surfaces the independent caregivers your investigators currently cannot pull a record on. | NPI-only lookup, blind to the independent caregiver workforce. |
| Evidence that holds up | One-click PDF and ROI panel where every flag links back to the official government record. | Your investigator hand-stitches CMS, OIG, state portals, and Google. |
| Built for LTC, not retrofitted | Designed around the operators, facilities, and caregivers that actually drive LTC loss. | Horizontal fraud platform with an LTC tab bolted on. |
What Carriers Ask Before They Stand Carpe LTC Up
Why is long-term-care fraud so hard to catch?+
One bad operator runs facility after facility, each under a fresh LLC name. The operator routes money to companies it secretly owns, thins staffing below what residents need, and stacks harm citations across the portfolio. Your claims operation pays into the pattern blind, because the evidence is scattered across a dozen unconnected government datasets and the open web. No single claim, no single facility review, and no single carrier ever sees the whole picture.
How does Carpe LTC go live without our claims data?+
The eight-signal operator graph runs on free, public federal data alone, so your SIU team gets ranked operators on day one with no data-use agreement to negotiate and no claims feed to wait on. Once your claims do flow in, the within-carrier detectors start lighting up the rings, double-billing, and provider clusters hiding inside your own book.
Why score the operator instead of the facility?+
The pattern sits at the operator, where the same actor hides behind dozens of LLCs, routes related-party dollars across them, and stacks harm citations across the portfolio. Scoring at the facility level fragments that signal into dozens of disconnected rows, while scoring at the operator level shows your team the actor and the pattern as one thing.
How big is the LTC exposure for carriers?+
Long-term-care claims are opening at a steep rate over the next five to ten years, with multi-billion-dollar exposure on the carrier side. The faster your team resolves the operator behind a facility, scores it on the eight signals, and surfaces patterns in your own book, the more of that exposure stays in front of an investigator instead of behind a paid claim.
Does Carpe LTC ever automatically deny a benefit?+
No, Carpe LTC recommends referrals and builds investigation packages and never automatically denies benefits, changes eligibility, or triggers external reporting. Every decision sits with your investigator, and that boundary is built into the workbench as a product rule that stays in place through every release.
Which public datasets feed the eight-signal graph?+
The full federal source register: CMS Provider Data, CMS Ownership, HCRIS cost reports, Payroll-Based Journal, CMS Survey Inspections, OIG LEIE, NPPES, and OSHA, plus selected open-source intelligence and state licensing for California, Illinois, New York, and Missouri. Additional states come online through a documented per-state plan, and every flag links back to the official government record behind it.
Where do most carriers start?+
Most carriers start with a slice of the book in one or two states, where your team gets back a ranked operator-and-harm list with every flag traced to a government source, ready for the next SIU stand-up. The within-carrier detectors come online once your claims connect.
See the Operators Hiding in Your LTC Book
Point Carpe LTC at a slice of your book in one or two states, and your team gets back a ranked operator-and-harm list with every flag traced to a government source, ready for the next SIU stand-up. The whole thing runs on public data we can stand up for any state in a day.