Book chapter
Identifying Physician Fraud in Healthcare with Open Data
Smart Health, pp.222-235
Lecture Notes in Computer Science, Springer International Publishing
12/02/2019
DOI: 10.1007/978-3-030-34482-5_20
Abstract
Health care fraud is a serious problem that impacts every patient and consumer. This fraudulent behavior causes excessive financial losses every year and causes significant patient harm. Healthcare fraud includes health insurance fraud, fraudulent billing of insurers for services not provided, and exaggeration of medical services, etc. To identify healthcare fraud thus becomes an urgent task to avoid the abuse and waste of public funds. Existing methods in this research field usually use classified data from governments, which greatly compromises the generalizability and scope of application. This paper introduces a methodology to use publicly available data sources to identify potentially fraudulent behavior among physicians. The research involved data pairing of multiple datasets, selection of useful features, comparisons of classification models, and analysis of useful predictors. Our performance evaluation results clearly demonstrate the efficacy of the proposed method.
Details
- Title: Subtitle
- Identifying Physician Fraud in Healthcare with Open Data
- Creators
- Brandon Fan - Virginia Tech ServicesXuan Zhang - Virginia Tech ServicesWeiguo Fan - University of Iowa
- Resource Type
- Book chapter
- Publication Details
- Smart Health, pp.222-235
- Publisher
- Springer International Publishing; Cham
- Series
- Lecture Notes in Computer Science
- DOI
- 10.1007/978-3-030-34482-5_20
- eISSN
- 1611-3349
- ISSN
- 0302-9743
- Language
- English
- Date published
- 12/02/2019
- Academic Unit
- Business Analytics
- Record Identifier
- 9984380511802771
Metrics
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