A study on the path of governance in health insurance fraud considering moral hazard [PDF]
Frontiers in Public Health, 2023 Combating health insurance fraud is of utmost importance to physicians, patients, and health insurers. To delve into the mechanisms of health insurance fraud between doctors and patients, this study employed evolutionary game theory to construct a model ...
Jusheng Liu, Yuan Wang, Jiali Yu
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Research on the Formation Mechanism of Health Insurance Fraud in China: From the Perspective of the Tripartite Evolutionary Game [PDF]
Frontiers in Public Health, 2022 The problem of fraud in China's health insurance has existed for a long time and is becoming more serious, which needs to be solved urgently. This article constructs a tripartite evolutionary game model to study the formation mechanism of the Health ...
Yun Fei +3 more
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Fourteen years of manifestations and factors of health insurance fraud, 2006–2020: a scoping review [PDF]
Health & Justice, 2021 Background Healthcare fraud entails great financial and human losses; however, there is no consensus regarding its definition, nor is there an inventory of its manifestations and factors.
José Villegas-Ortega +2 more
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Health insurance fraud detection by using an attributed heterogeneous information network with a hierarchical attention mechanism [PDF]
BMC Medical Informatics and Decision Making, 2023 Background With the rapid growth of healthcare services, health insurance fraud detection has become an important measure to ensure efficient use of public funds.
Jiangtao Lu +5 more
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Health insurance fraud detection based on multi-channel heterogeneous graph structure learning [PDF]
HeliyonHealth insurance fraud is becoming more common and impacting the fairness and sustainability of the health insurance system. Traditional health insurance fraud detection primarily relies on recognizing established data patterns.
Binsheng Hong +5 more
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Phenomenon of Causal Fraud Health Insurance in Hospitals: Theory of gear fraud
Asia Pacific Journal of Health Management, 2021 Objective: To describe and explore the experiences of hospital employees with the causes of fraud in the health insurance program at the hospitals. Design And Setting: This research was carried out at government hospitals in the Southeast Sulawesi ...
Haruddin Haruddin +2 more
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What influences the public’s willingness to report health insurance fraud in familiar or unfamiliar healthcare settings? a cross-sectional study of the young and middle-aged people in China [PDF]
BMC Public HealthIntroduction Young and middle-aged people are important participants in the fight against health insurance fraud. The study aims to investigate the differences in their willingness to report health insurance fraud and the factors influencing it when it ...
Jinpeng Xu +10 more
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Designing a national framework for preventing fraud in Iran’s health system: a sequential mixed-methods study using qualitative analysis and Delphi consensus [PDF]
BMJ OpenObjectives To design and validate a comprehensive, expert-informed national framework to prevent and control fraud and misconduct in Iran’s health system.
Elaheh Hooshmand, Ali Vafaee Najar
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Data driven healthcare insurance system using machine learning and blockchain technologies [PDF]
PeerJ Computer ScienceHealthcare recommendations and insurance have recently been one of the most emerging research areas in health informatics. The fraud in health insurance is becoming increasingly common day by day.
Irum Matloob +5 more
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Journal of Medical Internet ResearchBackgroundHealth care insurance fraud is on the rise in many ways, such as falsifying information and hiding third-party liability. This can result in significant losses for the medical health insurance industry.
Rima Kaafarani +2 more
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