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Health Care Insurance Fraud Detection Using Blockchain
2020 Seventh International Conference on Software Defined Systems (SDS), 2020The health care industry is one of the important service providers that improves people lives. As the cost of the healthcare service increases, health insurance becomes the only way to get quality service in case of an accident or a major illness. As health insurance will reduces the costs and provides financial and economic stability for an individual.
Gökay Saldamli +5 more
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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.
Shuli Wang +4 more
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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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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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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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Identifying Health Insurance Claim Frauds Using Mixture of Clinical Concepts
IEEE Transactions on Services Computing, 2022Patients depend on health insurance provided by the government systems, private systems, or both to utilize the high-priced healthcare expenses. This dependency on health insurance draws some healthcare service providers to commit insurance frauds. Although the number of such service providers is small, it is reported that the insurance providers lose ...
Md. Enamul Haque, Mehmet Engin Tozal
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Classification of Health Insurance Fraud Risk with Machine Learning
2024 International Conference on Information Technology Research and Innovation (ICITRI)Alexander Agung Santoso Gunawan
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Fraud Auditor: A Visual Analytics Approach for Collusive Fraud in Health Insurance
International Journal of Research Publication and ReviewsCollusive fraud in health insurance, involving coordinated deceit by multiple individuals, poses a significant challenge to the integrity of healthcare systems. Traditional fraud detection techniques often fall short in identifying such sophisticated patterns due to the subtle similarities between fraudulent and legitimate claims and the scarcity of ...
Mallarapu poojitha +1 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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