[PDF][PDF] Techniques of data mining in healthcare: a review
Data mining is gaining popularity in disparate research fields due to its boundless
applications and approaches to mine the data in an appropriate manner. Owing to the …
applications and approaches to mine the data in an appropriate manner. Owing to the …
Fourteen years of manifestations and factors of health insurance fraud, 2006–2020: a scoping review
Background Healthcare fraud entails great financial and human losses; however, there is no
consensus regarding its definition, nor is there an inventory of its manifestations and factors …
consensus regarding its definition, nor is there an inventory of its manifestations and factors …
An interactive machine-learning-based electronic fraud and abuse detection system in healthcare insurance
Detecting fraudulent and abusive cases in healthcare is one of the most challenging
problems for data mining studies. However, most of the existing studies have a shortage of …
problems for data mining studies. However, most of the existing studies have a shortage of …
[HTML][HTML] Responsible artificial intelligence in healthcare: Predicting and preventing insurance claim denials for economic and social wellbeing
It is estimated that one out of seven health insurance claims is rejected in the US; hospitals
across the country lose approximately $262 billion annually due to denied claims. This …
across the country lose approximately $262 billion annually due to denied claims. This …
Detecting insurance fraud using supervised and unsupervised machine learning
J Debener, V Heinke, J Kriebel - Journal of Risk and Insurance, 2023 - Wiley Online Library
Fraud is a significant issue for insurance companies, generating much interest in machine
learning solutions. Although supervised learning for insurance fraud detection has long …
learning solutions. Although supervised learning for insurance fraud detection has long …
[HTML][HTML] A survey on the state of healthcare upcoding fraud analysis and detection
From its infancy in the 1910s, healthcare group insurance continues to increase, creating a
consistently rising burden on the government and taxpayers. The growing number of people …
consistently rising burden on the government and taxpayers. The growing number of people …
Statistical medical fraud assessment: exposition to an emerging field
Health care expenditures constitute a significant portion of governmental budgets. The
percentage of fraud, waste and abuse within that spending has increased over years. This …
percentage of fraud, waste and abuse within that spending has increased over years. This …
WMTDBC: An unsupervised multivariate analysis model for fraud detection in health insurance claims
L Settipalli, GR Gangadharan - Expert Systems with Applications, 2023 - Elsevier
Fraud is an aggravating problem in the health insurance system, causing a substantial
increase in the cost of medical services. Many models have been developed using data …
increase in the cost of medical services. Many models have been developed using data …
[HTML][HTML] How to detect healthcare fraud?“A systematic review”
Objective To identify the method used in detecting fraud cases. Methods Articles searching
by using topic-appropriate keywords and incorporated into search engines (data-based) …
by using topic-appropriate keywords and incorporated into search engines (data-based) …
An intelligent unsupervised technique for fraud detection in health care systems
Healthcare is an essential part of people's lives, particularly for the elderly population, and
also should be economical. Medicare is one particular healthcare plan. Claims fraud is a …
also should be economical. Medicare is one particular healthcare plan. Claims fraud is a …