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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Artificial intelligence applications in health insurances: a scoping review [PDF]
Cost Effectiveness and Resource AllocationIntroduction The rapid evolution of technology has reshaped the insurance industry, with artificial intelligence (AI) taking center stage as a key driver of innovation.
Maryam Ramezani-a +11 more
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Holistic approach to fraud management in health insurance
Journal of Information and Organizational Sciences, 2008 Fraud present an immense problem for health insurance companies and the only way to fight fraud is by using specialized fraud management systems.
Štefan Furlan, Marko Bajec
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Examining the potential of mobile money-based health insurance for people living with HIV and hypertension or diabetes in Uganda [PDF]
Frontiers in Health ServicesBackgroundDigital technologies are increasingly promoted as alternative pathways for financing universal health coverage (UHC) in sub-Saharan Africa, yet evidence on their acceptability among informal-sector populations remains limited.
Henry Zakumumpa +6 more
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Using large language models for enhanced fraud analysis and detection in blockchain based health insurance claims [PDF]
Scientific ReportsTraditional health insurance claim processing systems are plagued by inefficiencies and vulnerabilities, often resulting in significant financial losses due to fraudulent activities.
Ruba Islayem +6 more
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Interdisciplinary Journal on Law, Social Sciences and Humanities, 2023 In this study, the author discusses one of the problems regarding the Urgency of Criminalization of Fraud in the Implementation of the Health Insurance Program in Indonesia.
Solehuddin Solehuddin
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A Study of Health Insurance Fraud in China and Recommendations for Fraud Detection and Prevention
Journal of Organizational and End User Computing, 2022 Healthcare insurance fraud influences not only organizations by overburdening the already fragile healthcare systems, but also individuals in terms of increasing premiums in health insurance and even fatalities. Identifying the behavioral characteristics of fraudulent claims can help shed light on the development of artificial intelligence and machine ...
Jie Li 0061 +4 more
openaire +1 more source
Prediction of Insurance Fraud Detection using Machine Learning Algorithms
Mehran University Research Journal of Engineering and Technology, 2022 In current era, people are influenced with various types of insurance such as health insurance, automobile insurance, property insurance and travel insurance, due to the availability of extensive knowledge related to insurance.
Laiqa Rukhsar +3 more
doaj +1 more source
Sequence Embeddings Help Detect Insurance Fraud
IEEE Access, 2022 Roughly 10 percent of the insurance industry’s incurred losses are estimated to stem from fraudulent claims. One solution is to use tabular data to construct models that can distinguish between claims that are legitimate and those that are ...
Ivan Fursov +6 more
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