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- Data-Centric AI for Healthcare Fraud Detection - PMC
Automated methods for detecting fraudulent healthcare providers have the potential to save billions of dollars in healthcare costs and improve the overall quality of patient care This study presents a data-centric approach to improve healthcare fraud classification performance and reliability using Medicare claims data
- Healthcare insurance fraud detection using data mining
In this study, a fraud detection methodology is presented that utilizes association rule mining augmented with unsupervised learning techniques to detect healthcare insurance fraud Dataset from the Centres for Medicare and Medicaid Services (CMS) 2008-2010 DE-SynPUF is used for analysis The proposed methodology works in two stages
- Fraud Detection in Healthcare Insurance Claims Using Machine . . . - MDPI
Therefore, supervised machine and deep learning analytics such as random forest, logistic regression, and artificial neural networks are successfully used to detect healthcare insurance fraud This study aims to develop a health model that automatically detects fraud from health insurance claims in Saudi Arabia
- Fraud detection in healthcare claims using machine learning: A . . .
Identifying fraud in healthcare programs is crucial, as an estimated 3%–10% of the total healthcare expenditures are lost to fraudulent activities This study presents a systematic literature review of machine learning techniques applied to fraud detection in health insurance claims
- Using Big Data Analytics to Detect Fraud in Healthcare Provision
Big Data technologies can contribute to medical fraud detection The aim of this paper is to present by an example, the methodological approach of the Hellenic
- Healthcare insurance fraud detection using data mining
Healthcare insurance fraud detection faces challenges from evolving and sophisticated fraud schemes that adapt to detection methods Analyzing extensive healthcare data is hindered by complexity, data quality issues, and the need for real-time detection, while privacy concerns and false positives pose additional hurdles
- Healthcare Provider Fraud Detection Analysis using Machine . . . - Medium
Here we will analyze and detect “Healthcare Provider Fraud” where the provider fills in all the details and makes a claim on behalf of the beneficiary Provider Fraud is one of the
- Healthcare Fraud Detection Using Machine Learning - IJCRT
By leveraging advanced analytics and predictive modelling techniques, machine learning algorithms can assist healthcare organisations in identifying suspicious claims, detecting anomalies, and mitigating fraudulent behaviour
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