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A Model System to Identify Health Care Frauds

Author(s):

Aditi Kamath , MODERN EDUCATION SOCIETY'S COLLEGE OF ENGINEERING,PUNE; Shraddha Hundalekar, MODERN EDUCATION SOCIETY'S COLLEGE OF ENGINEERING,PUNE; Pooja Divase, MODERN EDUCATION SOCIETY'S COLLEGE OF ENGINEERING,PUNE; Darshana Akadkar, MODERN EDUCATION SOCIETY'S COLLEGE OF ENGINEERING,PUNE; N. I. Ujloomwale, MODERN EDUCATION SOCIETY'S COLLEGE OF ENGINEERING,PUNE

Keywords:

Clustering Algorithms, Matrix Converters, Detection Algorithms, Insurance, Algorithm Design and Analysis, Drugs (Medicines), ANN, K-Means Clustering, Fuzzy Logic

Abstract

As the human life marches towards the modern amenities, all the sectors of life become more and more advanced, Health care is not spared from this. The revolutionary health care policy concept eventually facilitates all the patients irrespective of any cast and creed to avail the best services of the doctors for their diseases. Many of the health care insurance companies are existed to provide this facility for the peoples, but all of them are suffering from the headache of fraud insurance claims from the doctors. Many systems are existed to deal with these kinds of fraud health insurance claims from the doctors, but most of them are not up to the mark to identify the proper fraud detection operandi. So as a small step towards this, the proposed system develop a web application panel for both the doctors and insurance companies to identify the fraud claims of the doctors at the insurance company's end using Artificial Neural Network which is powered with fuzzy classification.

Other Details

Paper ID: IJSRDV5I120320
Published in: Volume : 5, Issue : 12
Publication Date: 01/03/2018
Page(s): 574-577

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