Healthcare Fraud Detection Techniques

Listing Websites about Healthcare Fraud Detection Techniques

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Healthcare Fraud Data Mining Methods: A Look Back and …

(3 days ago) WebThe fraud literature regarding the applications of advanced statistical techniques in various healthcare domains (medical, dental etc.) covers three main aspects of the business process: fraud detection, statistical sampling, and oversampling …

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9013219/

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AI and machine learning – an intelligent approach to …

(9 days ago) WebAI and ML can be used to detect and prevent healthcare fraud in the following ways. Analyzing large volumes of healthcare data to identify patterns of fraudulent …

https://www.hfma.org/cost-effectiveness-of-health/ai-and-machine-learning-an-intelligent-approach-to-healthcare-fraud-prevention/

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Combating Health Care Fraud and Abuse: …

(3 days ago) WebFurthermore, by automating a larger portion of the health care fraud detection system, cumbersome and tedious tasks such as the human review of health …

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7516680/

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Using Data Mining to Detect Health Care Fraud and …

(3 days ago) Web3. Related Works. Travaille, Müller, Thornton and Hillegersberg (2011) created an overview on fraud detection within other industries, and how they can be …

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4796421/

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Data mining application to healthcare fraud detection: a …

(2 days ago) WebThe healthcare sector is an interesting target for fraudsters. The availability of a great amount of data makes it possible to tackle this issue with the adoption of data …

https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-020-01143-9

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A Systematic Review and Qualitative Assessment of Fraud …

(6 days ago) WebApplying a previously validated approach that has not been taken by prior health care fraud reviews, our qualitative method showed high validity in terms of …

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

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Healthcare Fraud Data Mining Methods: A Look Back and …

(4 days ago) WebSome of the healthcare fraud schemes that are frequently discussed in the literature and used to develop fraud detection algorithms or analytics within regulatory entities are as follows

https://www.researchgate.net/publication/360086958_Healthcare_Fraud_Data_Mining_Methods_A_Look_Back_and_Look_Ahead

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Artificial Intelligence Solutions to Detect Fraud in …

(1 days ago) WebOut of 183 retrieved studies, 31 met all inclusion criteria. This review found that AI has been used to detect different types of fraud such as identify theft and …

https://pubmed.ncbi.nlm.nih.gov/35773795/

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Data-Centric AI for Healthcare Fraud Detection

(8 days ago) WebAutomated 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 …

https://link.springer.com/content/pdf/10.1007/s42979-023-01809-x.pdf

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

(9 days ago) WebIn this article, healthcare fraud detection systems and methods found in the literature are described and summarized and several research topics are proposed to fill the potential …

https://www.semanticscholar.org/paper/Healthcare-Fraud-Data-Mining-Methods%3A-A-Look-Back-Kumaraswamy-Markey/fbbf5844b1fd242908a4a0aa65c59a8f5f2d4472

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Detecting fraud in health care through emerging technologies

(7 days ago) WebThe traditional health care fraud detection methods, often limited to ex-post detection rather than fraud prevention, seem not to be efficient and effective, until now. …

https://www.issa.int/analysis/detecting-fraud-health-care-through-emerging-technologies

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Data-Centric AI for Healthcare Fraud Detection - PMC

(4 days ago) WebAs a result, most of the related healthcare fraud detection works employ advanced modeling techniques to address these challenges. In general, there is a lack …

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10173919/

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Healthcare insurance fraud detection using data mining

(1 days ago) WebHealthcare insurance fraud detection faces challenges from evolving and sophisticated fraud schemes that adapt to detection methods. Analyzing extensive …

https://pubmed.ncbi.nlm.nih.gov/38671513/

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A novel fraud detection and prevention method for healthcare …

(7 days ago) WebMany of these authors used machine learning techniques to identify, monitor, and detect the vulnerabilities found in Ethereum and other platform smart contracts.

https://www.sciencedirect.com/science/article/pii/S2772662222000534

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A survey on statistical methods for health care fraud detection

(1 days ago) WebFraud and abuse have led to significant additional expense in the health care system of the United States. This paper aims to provide a comprehensive survey of the statistical …

https://pubmed.ncbi.nlm.nih.gov/18826005/

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Predicting Healthcare Fraud in Medicaid: A - ScienceDirect

(7 days ago) WebThe research addresses a relevant and important problem in Medicaid healthcare fraud detection. This paper offers artifacts including a set of …

https://www.sciencedirect.com/science/article/pii/S2212017313002946

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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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Data-Centric AI for Healthcare Fraud Detection SN Computer …

(Just Now) WebAbstract. Automated methods for detecting fraudulent healthcare providers have the potential to save billions of dollars in healthcare costs and improve the overall …

https://link.springer.com/article/10.1007/s42979-023-01809-x

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

(9 days ago) WebThe fraud literature regarding the applications of advanced statistical techniques in various healthcare domains (medical, dental etc.) covers three main aspects of the business …

https://perspectives.ahima.org/page/healthcare-fraud-data-mining-methods-a-look-back-and-look-ahead

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Effective Fraud Detection in Healthcare Domain using Popular

(1 days ago) WebHealthcare-related programs such as Medicaid and Medicare are primarily targeted for such FAW acts. India spends overall 600-800 crs on fraudulent claims yearly …

https://www.ijitee.org/wp-content/uploads/papers/v8i11/K15780981119.pdf

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Data mining application to healthcare fraud detection: a two-step

(3 days ago) WebA small number of studies tried to tackle fraud detection by adopting supervised techniques [9 Mahmoodi M, Geraili B, Nasiri M, Arab M. Using data …

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362640/

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Healthcare Fraud Detection - Analytic and Data Mining Techniques

(2 days ago) WebHealthcare Fraud Detection. Fraudulent healthcare claims increase the burden to society. Therefore healthcare fraud detection is now becoming more and more important. …

https://roselladb.com/healthcare-fraud-detection.htm

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Healthcare insurance fraud detection using data mining - PMC

(4 days ago) WebIn this study, a fraud detection methodology is presented that utilizes association rule mining augmented with unsupervised learning techniques to detect …

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11046758/

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