A Application Model of Health Care System to Discover Fraud using Machine Learning Algorithm

In many advanced countries like USA, Europe and many more, including India is providing health insurance facility for their citizens. In this facility a patient need not to give any kind of upfront fees to the Doctor to get the desired services. After having the services doctor will claim his fees with the Insurance Company with all the details of the services provided to the patient. Here some Doctor may fall in greed and they may charge excess than that of actual charges, which is actually a fraud which gives rise to unethical practices. Some methodologies are existed to estimate the fraud claims raised by the Doctors at the health insurance service providers end. But it is always the question of a precision is raised. So as a tiny step towards this to improve the accuracy this paper proposes an idea of using the concept of Machine learning like K- Nearest Neighbor and Artificial Intelligence. This process is powered with Entropy Analysis and Logistic Regression.