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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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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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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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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IEEE Access, 2022 Nowadays, health insurance has become an essential part of people’s lives as the number of health issues increases. Healthcare emergencies can be troublesome for people who can’t afford huge expenses.
Khyati Kapadiya +6 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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A Fraud Detection Approach with Data Mining in Health Insurance
Procedia, Social and Behavioral Sciences, 2012 AbstractFraud can be seen in all insurance types including health insurance. Fraud in health insurance is done by intentional deception or misrepresentation for gaining some shabby benefit in the form of health expenditures. Data mining tools and techniques can be used to detect fraud in large sets of insurance claim data. Based on a few cases that are
Kirlidog, Melih, Asuk, Cuneyt
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FraudAuditor: A Visual Analytics Approach for Collusive Fraud in Health Insurance
IEEE Transactions on Visualization and Computer Graphics, 2023 12 pages, 7 ...
Jiehui Zhou, Xumeng Wang, Dongming Han
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