A scoring model to detect abusive billing patterns in health insurance claims

Expert Systems with Applications

Volumn 39, Issue 8, 2012, Pages 7441-7450

  Shin, Hyunjung ^a   Park, Hayoung ^b   Lee, Junwoo ^a   Jhee, Won Chul ^c  

^a Ajou University   (South Korea)

^b Seoul National University   (South Korea)

^c Hong Ik University   (South Korea)

Author keywords

Data mining; Degrees of anomaly; Fraud detection; Health insurance claims; Medical abuse detection

Indexed keywords

CONDITIONAL PROBABILITY DISTRIBUTIONS; CONFUSION MATRICES; DEGREES OF ANOMALY; DETECTION TECHNIQUE; ELECTRONIC HEALTHCARE; FRAUD DETECTION; HEALTH CARE COSTS; HOMOGENEOUS CLUSTER; INSURANCE CLAIMS; INTERNAL MEDICINE; MODEL VALIDATION; OUTPATIENT CLINIC; SCORING MODELS;

DATA MINING; DECISION TREES; HEALTH CARE; PROBABILITY DISTRIBUTIONS;

HEALTH INSURANCE;

EID: 84862811225     PISSN: 09574174     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.eswa.2012.01.105     Document Type: Article

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