Health Insurance Fraud Detection Methods

Healthcare Fraud Data Mining Methods: A Look Back and Look Ah…

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(4 days ago) People also askWhat are healthcare insurance fraud detection methods?Healthcare insurance fraud detection methods encompass using paper or electronic claims documents to compare and divide data into certain levels to segregate classes. According to scholars, there are various fraud detection methods; for instance, one depends on decoding the data into five stages.Fraud Detection in Healthcare Insurance Claims Using Machine Learningmdpi.comHow to detect healthcare fraud?Li et al. ( 2008) provided state-of-the-art statistical methods for healthcare fraud detection. The paper summarized various steps in detecting frauds including data pre-processing, handling missing values, and auditing health insurance claims.Provider profiling and labeling of fraudulent health insurance claims link.springer.comWhy is health insurance fraud detection important?With the rapid growth of healthcare services, health insurance fraud detection has become an important measure to ensure efficient use of public funds. Traditional fraud detection methods have tended to focus on the attributes of a single visit and have ignored the behavioural relationships of multiple visits by patients.Health insurance fraud detection by using an attributed heterogeneous bmcmedinformdecismak.biomedcentral.comWhat data mining techniques are used in healthcare fraud detection?Ahmad, Qamar, and Rizvi (2015) reviewed the state-of-the-art data mining techniques such as classification, clustering, association, and regression which are used to develop the healthcare fraud detection system. It also highlighted the applications, challenges, and advancements of data mining approaches applicable to the healthcare domain.WMTDBC: An unsupervised multivariate analysis model for fraud detecti…sciencedirect.comFeedbackScienceDirecthttps://www.sciencedirect.com/science/article/pii/S2405844024060766 Research article Health insurance fraud detection based on multi …WEBRecent heterogeneous graph-based approaches to health insurance fraud detection have been limited by a number of challenges. These methods focus on identifying possible frauds by calculating the importance of nodes and using anomaly …

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9013219/#:~:text=These%20techniques%20can%20be%20summarized%20from%20a%20fraud,of%20both%20supervised%20and%20unsupervised%20techniques%20are%20used.

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