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The healthcare industry is a complex system with many moving parts. One issue in this field is the misuse of medical insurance systems, such as Medicare. In this paper, we build a machine learning model to detect when physicians exhibit anomalous behavior in their medical insurance claims. This new research has the potential to give some insight in determining if, and when, physicians are acting outside...
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 enrolled in healthcare programs such as Medicare, along with the enormous volume of money in the healthcare industry, increases the appeal for and risk of fraudulent activities. One such fraud, known as upcoding, is a means...
Healthcare has and continues to be an integral component in people's lives, especially for the rising elderly population. One such healthcare program that provides for the needs of the elderly is Medicare. It is important that any such program be affordable but, unfortunately, this is not always the case. Out of the many possible factors for the rising cost of healthcare, fraud is a major contributor,...
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