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There is a lot of public information available about this stuff. I would start with looking into Zone Integrity Program Contractors (for Part A and B), Medicare Drug Ingretity Contracts (Part D), and Recovery Audit Contractors (Part A and B, mostly focusing on over and under paymentments through periodic auditing).

There are also groups you can find out more information on that handle fraud for medical labs that fall under CLEA regulation (Labs/PINS group) and ambulatory services fraud. There is also a contractor that's focused on provider screening services.

It's a pretty big subject to sum up how they're doing this but it does involve some interesting analysis techniques and there are plenty of pain points that could probably be improved.

It's really interesting and exciting work for technologist who want to get in on it.