Technical Architecture

Graph + AI Infrastructure for Care System Integrity

Real-time behavioral and network intelligence built for NDIS-scale complexity — designed to detect systemic risk across large-scale government care systems.

Technically, this is a dynamic, multi-relational graph system with temporal drift — not a flat relational dataset. Existing architecture was not designed for this complexity.

750K
Participants
270K
Providers
~M+
Monthly Transactions
Core Problem
Existing Architecture Is Not Graph-Aware
3

Batch Analytics

POST-EVENT ONLY — No real-time detection

2

Rule Engines

STATIC CONSTRAINTS — Lacks system-wide modeling

1

Relational Databases

CLAIMS-CENTRIC — Lacks relationship context

What's Missing

Current systems process transactions in isolation. There is no representation of:

  • → System-wide relationships between providers, participants, and workers
  • → Temporal evolution of behavior over time
  • → Emergent patterns across the network
Fraud and inefficiency are emergent graph properties — invisible to row-level queries.
Key Insight
Fraud & Inefficiency Are Emergent Properties of Graphs

Node Interactions

Hidden relationships between providers, participants, and workers create risk patterns invisible at the transaction level.

Temporal Drift

Gradual shifts in billing behavior, service mix, and growth trajectories signal systemic issues before they escalate.

Network Clusters

Collusive provider groups and synthetic behavior patterns form detectable community structures in the graph.

Constraint Violations

Physically impossible schedules — overlapping services, travel time gaps, staffing conflicts — reveal fabrication.

Solution Architecture
A 4-Layer Distributed Intelligence System
Each layer adds a dimension of intelligence — from raw relationship mapping through temporal modeling, physical validation, and finally graph-based risk scoring.
System Output
Risk Intelligence APIs — Not Raw Flags

Provider Risk Score

0-100 composite score aggregating all detection layers into a single actionable metric.

Network Cluster Risk Index

Community-level risk assessment for provider groups with shared infrastructure signals.

Behavioral Drift Score

Temporal deviation from established baseline patterns -- catching gradual fraud escalation.

Constraint Violation Events

Physically impossible schedules flagged in real time with forensic evidence.

Integrates with NDIA systems via real-time API or batch pipelines — no rip-and-replace required.
Vision
From Claims System → Intelligence System

Why CareIntegrity.ai Wins

CapabilityLegacyCareIntegrity.ai
Transaction fraud detection
Network-level detection
Temporal behavior modeling
Physical feasibility validation
Graph intelligence
Real-time risk scoringLimited

Performance Impact

  • 5–20× faster anomaly detection latency
  • Reduced false positives via context-aware graph models
  • Earlier detection of systemic fraud patterns
  • Improved audit targeting efficiency

Future Expansion

Aged care · Health insurance · Social welfare · Global public sector infrastructure

See the Intelligence Layer in Action

Live demo with 8 AI engines processing 98,966 claims across 60 providers in real-time.

Access Live Demo →
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