A study on the path of governance in health insurance fraud considering moral hazard [PDF]
Frontiers in Public Health, 2023 Combating health insurance fraud is of utmost importance to physicians, patients, and health insurers. To delve into the mechanisms of health insurance fraud between doctors and patients, this study employed evolutionary game theory to construct a model ...
Jusheng Liu, Yuan Wang, Jiali Yu
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Fourteen years of manifestations and factors of health insurance fraud, 2006–2020: a scoping review [PDF]
Health & Justice, 2021 Background Healthcare fraud entails great financial and human losses; however, there is no consensus regarding its definition, nor is there an inventory of its manifestations and factors.
José Villegas-Ortega +2 more
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Insurance Fraud in Korea, Its Seriousness, and Policy Implications [PDF]
Frontiers in Public Health, 2021 Several characteristics of insurance fraud including its chronic nature justifies the need for identifying feasible proposals which can be expected to bring about significant impacts. Recent statistics show that insurance fraud is now consistently on the
Jeyong Jung, Byung-Jik Kim
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Health insurance fraud detection based on multi-channel heterogeneous graph structure learning [PDF]
HeliyonHealth insurance fraud is becoming more common and impacting the fairness and sustainability of the health insurance system. Traditional health insurance fraud detection primarily relies on recognizing established data patterns.
Binsheng Hong +5 more
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What are people’s attitudes toward medical insurance fraud whistleblowers? a study from China [PDF]
BMC Public HealthPurpose Medical insurance fraud has caused huge losses to countries around the world, and public reporting has become an important means to combat medical insurance fraud.
Fangting Chen +11 more
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Research on the Formation Mechanism of Health Insurance Fraud in China: From the Perspective of the Tripartite Evolutionary Game [PDF]
Frontiers in Public Health, 2022 The problem of fraud in China's health insurance has existed for a long time and is becoming more serious, which needs to be solved urgently. This article constructs a tripartite evolutionary game model to study the formation mechanism of the Health ...
Yun Fei +3 more
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Health insurance fraud detection by using an attributed heterogeneous information network with a hierarchical attention mechanism [PDF]
BMC Medical Informatics and Decision Making, 2023 Background With the rapid growth of healthcare services, health insurance fraud detection has become an important measure to ensure efficient use of public funds.
Jiangtao Lu +5 more
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What influences the public’s willingness to report health insurance fraud in familiar or unfamiliar healthcare settings? a cross-sectional study of the young and middle-aged people in China [PDF]
BMC Public HealthIntroduction Young and middle-aged people are important participants in the fight against health insurance fraud. The study aims to investigate the differences in their willingness to report health insurance fraud and the factors influencing it when it ...
Jinpeng Xu +10 more
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Why Not Blow the Whistle on Health Care Insurance Fraud? Evidence from Jiangsu Province, China [PDF]
Risk Management and Healthcare Policy, 2022 Dandan Wang, Changchun Zhan School of Management, Jiangsu University, Zhenjiang, People’s Republic of ChinaCorrespondence: Changchun Zhan, Tel +86-15952808385, Email Zcc1973@126.comPurpose: To identify the factors that influence whistleblowing behavior ...
Wang D, Zhan C
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Journal of Medical Internet ResearchBackgroundHealth care insurance fraud is on the rise in many ways, such as falsifying information and hiding third-party liability. This can result in significant losses for the medical health insurance industry.
Rima Kaafarani +2 more
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