Health Insurance Fraud Research Paper

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Fourteen years of manifestations and factors of health insurance …

(3 days ago) WEB“Health insurance fraud is an act based on deceit or intentional misrepresentation to obtain illegal benefits concerning the coverage provided by health …

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8482647/

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A study on the path of governance in health insurance fraud …

(4 days ago) WEBCombating health insurance fraud is of utmost importance to physicians, patients, and health insurers. To delve into the mechanisms of health insurance fraud …

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10543491/

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Fourteen years of manifestations and factors of health insurance …

(5 days ago) WEBHealthcare fraud entails great financial and human losses; however, there is no consensus regarding its definition, nor is there an inventory of its manifestations and …

https://healthandjusticejournal.biomedcentral.com/articles/10.1186/s40352-021-00149-3

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Health insurance fraud detection based on multi-channel …

(7 days ago) WEBRecent heterogeneous graph-based approaches to health insurance fraud detection have been limited by a number of challenges. These methods focus on …

https://www.sciencedirect.com/science/article/pii/S2405844024060766

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Categorizing and Describing the Types of Fraud in Healthcare

(7 days ago) WEBConclusions and Future Research This paper provides a systematic literature review of health insurance fraud types in published works. Much work has been done …

https://www.sciencedirect.com/science/article/pii/S1877050915027295

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A Systematic Review and Qualitative Assessment of Fraud …

(6 days ago) WEBHealth care fraud is a costly, challenging problem in health insurance. This study provides a systematic evaluation and synthesis of the methodologies and data …

https://www.tandfonline.com/doi/full/10.1080/10920277.2021.1895843

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(PDF) Fraud Detection and Analysis for Insurance Claim

(2 days ago) WEBFraud Detection and Analysis for Insurance Claim using Machine Learning. March 2022. DOI: 10.1109/SPICES52834.2022.9774071. Conference: 2022 IEEE …

https://www.researchgate.net/publication/360646224_Fraud_Detection_and_Analysis_for_Insurance_Claim_using_Machine_Learning

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A Review of Fraudulent Practices in Healthcare Insurance and …

(6 days ago) WEBHealthcare insurance fraud is a complex and costly problem that has become a concern globally. Traditional methods of detecting fraudulent claims and requests are time …

https://ieeexplore.ieee.org/document/10345969/

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Health insurance fraud detection by using an attributed …

(2 days ago) WEBHealth insurance fraud detection problem with an AHIN. The health insurance fraud detection problem can be defined by modelling different objects and …

https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-023-02152-0

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Risks Free Full-Text Fraud Detection in Healthcare Insurance …

(9 days ago) WEBThis study aims to develop a health model that automatically detects fraud from health insurance claims in Saudi Arabia. The model indicates the greatest …

https://www.mdpi.com/2227-9091/11/9/160

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Analyses and Detection of Health Insurance Fraud Using Data

(1 days ago) WEBFraud can be witnessed in all insurance types including health insurance. In health insurance industry, fraud is committed by intentional dissimulation or …

https://link.springer.com/chapter/10.1007/978-981-10-5699-4_5

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Blockchain and AI-Empowered Healthcare Insurance Fraud …

(5 days ago) WEBMotivated by these facts, we present a systematic survey for Artificial Intelligence (AI) and blockchain-enabled secure health insurance fraud detection in …

https://ieeexplore.ieee.org/document/9843995/

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Models for Detecting Frauds in Medical Insurance SpringerLink

(1 days ago) WEBIn this paper a thorough investigation is done over the health insurance fraud detection problem, solved by building several Machine Learning models. Our goal …

https://link.springer.com/chapter/10.1007/978-3-031-04206-5_5

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(PDF) Fraud Detection in Healthcare Insurance Claims

(Just Now) WEBa health model that automatically detects fraud from health insurance claims in Saudi Arabia. The model indicates the greatest contributing factor to fraud with …

https://www.researchgate.net/publication/373704234_Fraud_Detection_in_Healthcare_Insurance_Claims_Using_Machine_Learning

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Medical Fraud and Abuse Detection System Based on Machine …

(3 days ago) WEBAbstract. It is estimated that approximately 10% of healthcare system expenditures are wasted due to medical fraud and abuse. In the medical area, the …

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579458/

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Fraudulent Detection in Healthcare Insurance SpringerLink

(1 days ago) WEBThis paper compares the performance of five unsupervised algorithms in health insurance fraud detection. The five algorithms are “isolation forest (IF), …

https://link.springer.com/chapter/10.1007/978-981-15-9019-1_1

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Health insurance fraud detection based on multi-channel

(2 days ago) WEBHealth insurance fraud is becoming more common and impacting the fairness and sustainability of the health insurance system. Traditional health insurance fraud …

https://ui.adsabs.harvard.edu/abs/2024Heliy..1030045H/abstract

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An Improved Approch For Fraud Detection In Health …

(Just Now) WEBResearch Paper Network Security and Communication ISSN: 2321-3256 Health Insurance fraud encompasses a wide range of implicit practices and illegal acts …

https://www.ijsrnsc.org/pub_paper/IJSRNSC/5-IJSRNSC-0210.pdf

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Fraud detection in health insurance using data mining techniques

(3 days ago) WEBFraud is widespread and very costly to the healthcare insurance system. Fraud involves intentional deception or misrepresentation intended to result in an unauthorized benefit. …

https://ieeexplore.ieee.org/abstract/document/7045689

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Business Analytics: Emerging Practice and Research Issues in the …

(1 days ago) WEBThis paper summarizes emerging practice and research issues in the health insurance industry. We provide an industry overview, epitomize business analytics …

https://journals.sagepub.com/doi/10.1111/poms.13976

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The Demand for Health Insurance Among Uninsured …

(6 days ago) WEBprivate insurance on state-run health insurance exchanges.2 Relying on existing research to predict the e ects of such a fundamental reform on the currently uninsured …

https://www.nber.org/system/files/working_papers/w16978/w16978.pdf

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Safeguarding Research Using Federal Health Insurance Data

(7 days ago) WEBFor decades, researchers have relied on federal health care data to answer seminal questions in clinical medicine and health policy. Administrative claims data …

https://jamanetwork.com/journals/jama/fullarticle/2818453

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Financial Statement Fraud - Wiley Online Library

(9 days ago) WEBFor general information on our other products and services or for technical support, please contact our Customer Care Department within the United States at (800) 762-2974, …

https://onlinelibrary.wiley.com/doi/pdf/10.1002/9781118527436.fmatter

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I N D I C T M E N T - United States Department of Justice

(5 days ago) WEBMedicare was a federal health insurance program established by the Social Security Act of 1965, codified as referred to as “reimbursement,” submitted on behalf of a health care …

https://www.justice.gov/archive/usao/nj/Press/files/pdffiles/Older/cavalli%20etalindictment.pdf

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Strengthening Medicare and the care economy Budget 2024–25

(5 days ago) WEBThe Government is investing $2.8 billion to continue its commitment to strengthen Medicare. This includes the $1.2 billion package to address pressures facing the health system, …

https://budget.gov.au/content/04-medicare.htm

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