Results 21 to 30 of about 161,871 (263)
Kuwait Journal of Science, 2022 Fraud on health insurance has an impact not only on cost overruns, but also a decline in the quality of health services in long term. The use of machine learning to predict fraud on health insurance is increasingly popular.
Ranu Agastya Nugraha +2 more
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Explainable machine learning models for Medicare fraud detection
Journal of Big Data, 2023 As a means of building explainable machine learning models for Big Data, we apply a novel ensemble supervised feature selection technique. The technique is applied to publicly available insurance claims data from the United States public health insurance
John T. Hancock +3 more
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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
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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
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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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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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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
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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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