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As the number of electronic insurance claims increases each year, it is difficult to detect insurance fraud in a timely manner by manual methods alone. The objective of this study is to use classification modeling techniques to identify suspicious policies to assist manual inspections. The predictive models can label high-risk policies and help investigators to focus on suspicious records and accelerate...
Health insurance fraud detection is an important and challenging task. Traditionally, insurance companies use human inspections and heuristic rules to detect fraud. As the size of databases increases, the traditional approaches may miss a great portion of fraud for two main reasons. First, it is impossible to detect all health care fraud by manual inspection over large databases. Second, new types...
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