Graph Analysis for Detecting Fraud, Waste, and Abuse in Healthcare Data
نویسندگان
چکیده
منابع مشابه
Graph Analysis for Detecting Fraud, Waste, and Abuse in Healthcare Data
Detection of fraud, waste, and abuse (FWA) is an important yet difficult problem. In this paper, we describe a system to detect suspicious activities in large healthcare claims datasets. Each healthcare dataset is viewed as a heterogeneous network of patients, doctors, pharmacies, and other entities. These networks can be large, with millions of patients, hundreds of thousands of doctors, and t...
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Feds are trying hard to plug the numerous holes in the healthcare dam. The Obama administration announced on June 25, 2014 that a new anti-fraud program in Medicare doubled the amount of improper payments it identified or prevented this year.3 The Fraud Prevention System at CMS recovered or prevented more than $210 million of improper payments in its second year, the agency told Congress in a r...
متن کاملthe clustering and classification data mining techniques in insurance fraud detection:the case of iranian car insurance
با توجه به گسترش روز افزون تقلب در حوزه بیمه به خصوص در بخش بیمه اتومبیل و تبعات منفی آن برای شرکت های بیمه، به کارگیری روش های مناسب و کارآمد به منظور شناسایی و کشف تقلب در این حوزه امری ضروری است. درک الگوی موجود در داده های مربوط به مطالبات گزارش شده گذشته می تواند در کشف واقعی یا غیرواقعی بودن ادعای خسارت، مفید باشد. یکی از متداول ترین و پرکاربردترین راه های کشف الگوی داده ها استفاده از ر...
Combination of Ensemble Data Mining Methods for Detecting Credit Card Fraud Transactions
As we know, credit cards speed up and make life easier for all citizens and bank customers. They can use it anytime and anyplace according to their personal needs, instantly and quickly and without hassle, without worrying about carrying a lot of cash and more security than having liquidity. Together, these factors make credit cards one of the most popular forms of online banking. This has led ...
متن کاملImproving Fraud and Abuse Detection in General Physician Claims: A Data Mining Study
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. Methods We applied data mining approach to a major health insurance organization dataset of private sector general physicians’ prescription claims. It involved 5 ste...
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ژورنال
عنوان ژورنال: AI Magazine
سال: 2016
ISSN: 2371-9621,0738-4602
DOI: 10.1609/aimag.v37i2.2630