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A Model System to Identify Health Care Fraud using Machine Learning

Author(s):

Keval B. Randive , KJ College of Engineering and Management Research Pune; Mayuresh Bodke, KJ College of Engineering and Management Research Pune

Keywords:

Artificial Intelligence, Artificial Neural Network ANN, Data Analytics, Machine Learning

Abstract

Healthcare is very essential in people’s lives and it must be affordable. The healthcare industry is an intricate system with numerous moving components. As the human life moving towards the modern amenities, all the sectors of life become more and more advanced. 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 suffer from the fraud insurance claims from the doctors. Many systems are existed to deal with these kinds of frauds, but most of them are not up to the mark to identify the proper fraud detection operandi frauds. In this paper, we attempt to give a review on frauds in healthcare industry. So as a tiny step towards this, we have proposed system which will develop an application panel for the insurance companies to identify the fraud claims of the doctors at in-surance company’s end. We are using ANN powered with Logistic regression model by using K-nearest Neighbor algorithm.

Other Details

Paper ID: IJSRDV6I120038
Published in: Volume : 6, Issue : 12
Publication Date: 01/03/2019
Page(s): 684-685

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