Results 21 to 30 of about 161,189 (267)
Improving Fraud and Abuse Detection in General Physician Claims: A Data Mining Study [PDF]
International Journal of Health Policy and Management, 2016 Background We aimed to identify the indicators of healthcare fraud and abuse in general physicians’ drug prescription claims, and to identify a subset of general physicians that were more likely to have committed fraud and abuse.
Hossein Joudaki +6 more
doaj +1 more source
SHS Web of Conferences, 2018 In Indonesia, the fraud of healthcare service implementation occurs widely in hospitals, thereby harming the participants of social insurance. The objectives of research were to find out, to analyze, and to give solution to the fraud in the healthcare ...
Pustika Sukma Dara +2 more
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Fraud detection in supplementary health insurance based on smart contract in blockchain network [PDF]
Mathematics and Modeling in FinanceThis study aims to examine the function of blockchain technology to detect fraud in health insurance. we consider the literature on fraud in health insurance, blockchain, and smart contracts to to test a newly structured software system based on ...
Abbas Raad, Reza Ofoghi, Ghadir Mahdavi
doaj +1 more source
Good Governance and Anti-Corruption: Responsibility to Protect Universal Health Care in Indonesia
Hasanuddin Law Review, 2018 The establishment of universal health care marks a new momentum for the progressive realization of the right to health in Indonesia. The problem of corruption in health sector endangers the sustainability of effective and quality health care, therefore ...
Ratna Juwita
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Fraud and Abuse in the Saudi Healthcare System: A Triangulation Analysis
Inquiry: The Journal of Health Care Organization, Provision, and Financing, 2020 In the insurance industry, the majority of fraud and abuse cases fall into a limited number of patterns, yet false claims normally lead to negative national, local, and organizational effects.
Wadi B. Alonazi
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How to detect healthcare fraud? “A systematic review”
Gaceta Sanitaria, 2021 Objective: To identify the method used in detecting fraud cases. Methods: Articles searching by using topic-appropriate keywords and incorporated into search engines (data-based) journals Pubmed/Medline, Cochrane, Wiley, ScienceDirect, and secondary data-
Andi Yaumil Bay R. Thaifur +3 more
doaj +1 more source
Fraud Detection in Healthcare Insurance Claims Using Machine Learning
Risks, 2023 Healthcare fraud is intentionally submitting false claims or producing misinterpretation of facts to obtain entitlement payments. Thus, it wastes healthcare financial resources and increases healthcare costs.
Eman Nabrawi, Abdullah Alanazi
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Journal of Engineering, 2019 Fraud in health insurance claims has become a significant problem whose rampant growth has deeply affected the global delivery of health services. In addition to financial losses incurred, patients who genuinely need medical care suffer because service ...
Robert A. Sowah +6 more
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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 +9 more
openaire +3 more sources
Jurnal Jaminan Kesehatan Nasional, 2021 The Minister of Health Regulation (PMK) Number 16 of 2019 concerning Fraud Prevention in the National Health Insurance Program (JKN) as a substitute for Minister of Health Regulation Number 36 of 2015 is still being evaluated and studied in its ...
Dina Anjayani
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