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Fraud, waste, and abuse in medical insurance contributes to significant increases in costs for providers and patients. One way to reduce costs is through the detection of abnormal medical practices that could indicate possible fraud. In this paper, we expand upon our previous research into medical specialty anomaly detection by validating the efficacy of our model using real-world fraud cases, and...
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...
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