Medical Fraud Detection

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Health Care Fraud — FBI - Federal Bureau of Investigation

https://www.fbi.gov/investigate/white-collar-crime/health-care-fraud

If you suspect fraud, contact your health insurance company (most have toll free numbers to report fraudulent activity). Medicare fraud can be reported to 1-800-HHS-TIPS (1-800-447-8477). You also can contact your local FBI or HHS-OIG offices or your states Medicaid fraud office. See more

Health Care Fraud Detection and Investigation Software

https://www.sas.com/en_us/software/detection-investigation-for-health-care.html

Includes a health-care-specific fraud, waste and abuse data model that consolidates data from internal and external sources – claims systems, watch lists, third parties, …

The Challenge of Health Care Fraud – NHCAA

https://www.nhcaa.org/tools-insights/about-health-care-fraud/the-challenge-of-health-care-fraud/

Many states also have responded vigorously to the threat of health care fraud, not only by strengthening their insurance fraud laws and penalties, but also by requiring health …

Detecting health care claims fraud | SAS

https://www.sas.com/en_us/insights/articles/risk-fraud/detect-health-care-claims-fraud.html

Researchers concluded that as of 2015, fraud and error losses in any organization are at least 3 percent, probably more than 5 percent and possibly more than 10 percent. At the …

Detecting fraud in health care through emerging …

https://ww1.issa.int/analysis/detecting-fraud-health-care-through-emerging-technologies

The 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. …

Unsupervised Machine Learning for Explainable Health …

https://www.nber.org/papers/w30946

Unsupervised Machine Learning for Explainable Health Care Fraud Detection. Shubhranshu Shekhar, Jetson Leder-Luis & Leman Akoglu. Working Paper …

Health care fraud detection A survey and a …

http://raw.rutgers.edu/docs/wcars/29wcars/Health%20care%20fraud%20detection%20A%20survey%20and%20a%20clustering%20model%20incorporating%20Geo-location%20information.pdf

[12] has developed an expert system, called electronic fraud detection, to detect service providers’ fraud. This system based on unsupervised rule-based algorithm to scan health …

Detecting Medical Fraud (Part 1) — Data Acquisition

https://medium.com/swlh/detecting-medical-fraud-part-1-data-acquisition-preprocessing-e8f3206b9bac

Detecting Medical Fraud (Part 1) — Data Acquisition & Preprocessing | by Rayhaan Rasheed | The Startup | Medium Write Sign up Sign In 500 Apologies, but …

Fraud Detection in Healthcare - Towards Data Science

https://towardsdatascience.com/fraud-detection-in-healthcare-1801bf19d36c

Fraud Detection in Healthcare. Identifying Suspicious Healthcare… | by Nishant Mohan | Towards Data Science Write Sign up Sign In 500 Apologies, but something went wrong on our end. Refresh …

HEALTHCARE PROVIDER FRAUD DETECTION …

https://www.kaggle.com/datasets/rohitrox/healthcare-provider-fraud-detection-analysis

Healthcare fraud is an organized crime which involves peers of providers, physicians, beneficiaries acting together to make fraud claims. Rigorous analysis of Medicare data …

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