Healthcare programs and insurance initiatives play a crucial role in ensuring that people have access to medical care. There are many benefits of healthcare insurance programs but fraud in healthcare continues to be a significant challenge in the insuran
The healthcare insurance system involves mainly three actors - the insured, medical institutions, and insurance providers as depicted in the Fig.2. Each actor may have different interests that can lead to fraud, for example, over-diagnosis and treatment by hospitals, fake medical treatment by insu...
Fraud is widespread and very costly to the healthcare insurance system. Fraud involves intentional deception or misrepresentation intended to result in an unauthorized benefit. It is shocking because the incidence of health insurance fraud keeps increasing every year. In order to detect and avoi...
Health Care Fraud is a Crime Health care fraud is committed when someone intentionally submits, or causes someone else to submit, false or misleading information for use in determining the amount of health care benefits payable. That is a crime. Any per
Fraud is widespread and very costly to the healthcare insurance system. Fraud involves intentional deception or misrepresentation intended to result in an unauthorized benefit. It is shocking because the incidence of health insurance fraud keeps increasing every year. In order to detect and avoid the...
Industry-leading healthcare insurance companies rely on the HCFSPlatform®for Fraud, Waste, Abuse, and Error to deliver millions of dollars in savings, recoveries, and prevented loss each year – a critical component of your companyʼs payment integrity strategy. ...
Keeping in mind the business value of the fraudulent claims, the research work seeks to develop a systemic methodology of modeling the information in such a way that the defined business goals in healthcare fraud management are achieved. Given the nature of insurance industry, the currently ...
Results: In recent years, there has been a surge in publications centered on the use of machine learning to detect health insurance fraud. Among these studies, those focused on the detection of fraud committed by healthcare providers was the most prevalent, followed by fraud committed by ...
Rotterdam-based DSW provides individual and business/corporate health insurance for roughly 600,000 policyholders in the Netherlands and is the fifth-largest health care insurer in the country. “Fraud and inappropriate use of health care is a growing problem for every insurer,” says Van den ...
Healthcare insurance fraud detection using data mining Healthcare programs and insurance initiatives play a crucial role in ensuring that people have access to medical care. There are many benefits of healthcar... Z Hamid,F Khalique,S Mahmood,... - 《Bmc Medical Informatics & Decision Making》...