Results 221 to 230 of about 161,189 (267)
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Multi-stage methodology to detect health insurance claim fraud
Health Care Management Science, 2015Healthcare costs in the US, as well as in other countries, increase rapidly due to demographic, economic, social, and legal changes. This increase in healthcare costs impacts both government and private health insurance systems. Fraudulent behaviors of healthcare providers and patients have become a serious burden to insurance systems by bringing ...
Marina Evrim, Johnson, Nagen, Nagarur
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Health Insurance Fraud Detection
2011Health insurance fraud detection is an important and challenging task. Traditional heuristic-rule based fraud detection techniques can not identify complex fraud schemes. Such a situation demands more sophisticated analytical methods and techniques that are capable of detecting fraud activities from large databases.
Yong Shi +4 more
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Fraud detection in health insurance using data mining techniques
2015 International Conference on Communication, Information & Computing Technology (ICCICT), 2015Fraud is widespread and very costly to the healthcare insurance system. Fraud involves intentional deception or misrepresentation intended to result in an unauthorized benefit. It is shocking because the incidence of health insurance fraud keeps increasing every year. In order to detect and avoid the fraud, data mining techniques are applied.
Vipula Rawte, G Anuradha
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Application of Clustering Methods to Health Insurance Fraud Detection
2006 International Conference on Service Systems and Service Management, 2006Health insurance fraud detection is an important and challenging task. Traditionally, insurance companies use human inspections and heuristic rules to detect fraud. As the size of databases increases, the traditional approaches may miss a great portion of fraud for two main reasons.
Yi Peng +5 more
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Fraud detection using outlier predictor in health insurance data
2017 International Conference on Information Communication and Embedded Systems (ICICES), 2017In day today life, health insurance data collection plays major role for employers. In several countries misbehavior in health insurance is a major problem. Health insurance data fraud is an intentional act of misleading, hiding or misrepresenting information that makes profit to a single or group of members. These kind of violation leads to major loss
M. S. Anbarasi, S. Dhivya
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The evaluation of trustworthiness to identify health insurance fraud in dentistry
Artificial Intelligence in Medicine, 2017According to the investigations of the U.S. Government Accountability Office (GAO), health insurance fraud has caused an enormous pecuniary loss in the U.S. In Taiwan, in dentistry the problem is getting worse if dentists (authorized entities) file fraudulent claims.
Shu-Li, Wang +4 more
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Managerial and Decision Economics
ABSTRACTThis paper adds to the literature on the determinants of health insurance by focusing especially on the spillovers from culture and fraud, along with a set of “standard” determinants. The social aspects of culture and fraud could potentially increase or decrease the propensities of individuals to purchase health insurance, and our empirical ...
Rajeev K. Goel +2 more
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ABSTRACTThis paper adds to the literature on the determinants of health insurance by focusing especially on the spillovers from culture and fraud, along with a set of “standard” determinants. The social aspects of culture and fraud could potentially increase or decrease the propensities of individuals to purchase health insurance, and our empirical ...
Rajeev K. Goel +2 more
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Financial fraud in the private health insurance sector in Australia
Journal of Financial Crime, 2015Purpose– The purpose of this article is to explore financial fraud in the private health insurance sector in Australia. Fraud in this sector has commonalities to other countries with similar health systems but in Australia it has garnered some unique characteristics.
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Framework for Analysis and Detection of Fraud in Health Insurance
2019 IEEE 6th International Conference on Cloud Computing and Intelligence Systems (CCIS), 2019The health insurance industry generates a wide range of data from patients' information to provider payment and claims report. The impact of fraud, waste, and abuse (FWA) in medical management is on the rise and contributes significantly to the increase in cost. Traditional methods of handling fraud include human inspection and heuristic rules.
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