Results 61 to 70 of about 161,871 (263)

Post Claims Underwriting and Rescission Practices [PDF]

, 2009
Based on case studies in four states, examines the effectiveness of regulation of the individual health insurance market and consumer protections against insurers canceling, rescinding, or limiting coverage after claims are submitted.
Hilary Haycock, Meredith King Ledford, Peter Harbage   +2 more
core  

Outlier-based Health Insurance Fraud Detection for U.S. Medicaid Data [PDF]

Proceedings of the 16th International Conference on Enterprise Information Systems, 2014
Fraud, waste, and abuse in the U.S. healthcare system are estimated at $700 billion annually. Predictive analytics offers government and private payers the opportunity to identify and prevent or recover such billings. This paper proposes a data-driven method for fraud detection based on comparative research, fraud cases, and literature review ...
Dallas Thornton, Guido van Capelleveen, Mannes Poel, Jos van Hillegersberg, Roland M. Müller   +4 more
openaire   +1 more source

Artificial Intelligence–Driven and Digital Practices for Circular Business and Finance: Insights for Advancing Hubs for Circularity

Business Strategy and the Environment, EarlyView.
ABSTRACT The emerging concept of Hubs for Circularity (H4Cs) presents an opportunity to create collaborative, self‐sustaining regional industrial ecosystems that drive circular economy transitions at scale. However, the operationalisation of H4Cs faces financial, organisational and data‐driven challenges.
Aditya Tripathi, Marcos R. Machado, Laura Spierdijk, Devrim Murat Yazan   +3 more
wiley   +1 more source

Methodology for Detecting Suspicious Claims in Health Insurance Using Supervised Machine Learning

Future Internet
Health insurance fraud (HIF) places a substantial economic burden on global health systems. While supervised machine learning (SML) offers a promising solution for its detection, most approaches are ad hoc and lack a systematic methodological framework ...
Jose Villegas-Ortega, Luis Napoleon Quiroz Aviles, Juan Nazario Arancibia, Wilder Carpio Montenegro, Rosa Delgadillo, David Mauricio   +5 more
doaj   +1 more source

Primer on Post Claims Underwriting and Rescission Practices: Findings From Texas in the Individual Health Insurance Market [PDF]

, 2009
Explains the practice of insurers canceling, rescinding, or limiting coverage after claims are submitted and the variations in regulations and enforcement.
Hilary Haycock, Peter Harbage
core  

ESG Controversies in Global Firms: A Black Mark?

Business Strategy and the Environment, EarlyView.
ABSTRACT Despite increasing attention paid by companies to sustainability, there is still evidence of environmental, social and governance (commonly referred to as ESG) scandals. As research on this topic is scant, this paper aims to analyse the impact of ESG controversies on firms' sustainability practices, that is, ESG policies, as well as ...
Beatrice Bais, Guido Orzes, Marco Sartor
wiley   +1 more source

Factors Causing Fraud in Hospitals Under National Health Insurance and Prevention Strategies: A Scoping Review

Jurnal Jaminan Kesehatan Nasional
Fraud in the implementation of the National Health Insurance program poses a significant challenge to hospital governance in Indonesia, resulting in financial losses and eroding public trust in healthcare services.
Silmi Noor Rachni, Vetty Yulianty Permanasari   +1 more
doaj   +1 more source

Optimization of Fraud Potential Prevention in Implementation of National Health Insurance at Puskesmas Abeli

Journal of Health Science and Prevention, 2019
Fraud actions at institutions can catapult health costs. Globally, the potential loss due to fraud is estimated at 7,29% every year. Increasing the number of referrals in advanced health facilities FKTL is an indication of fraud behavior.
Sartini Risky MS, Asbath Said
doaj   +1 more source

Semi-Annual Report to Congress for the Period of October 1, 2002 to March 31, 2003 [PDF]

, 2001
[Excerpt] It is a privilege to transmit this Semiannual Report to the Congress covering the period October 1, 2002, through March 31, 2003, summarizing the significant audit and investigative activities of the Office of Inspector General (OIG), U.S ...
Office of the Inspector General
core   +7 more sources

Autonomous Leadership: How Board Independence Shapes Machine Learning Based Corporate Culture in Thailand

Corporate Social Responsibility and Environmental Management, EarlyView.
ABSTRACT Corporate culture is a critical driver of corporate social responsibility, shaping how firms internalize sustainability, social and environmental concerns, yet its governance antecedents are less understood. Motivated by the need to understand how governance structures affect organizational values and behavior, we explore the relationship ...
Sirimon Treepongkaruna, Stefano Starita
wiley   +1 more source