The increment of computer technology use and the continued growth of companies have
enabled most financial transactions to be performed through the electronic commerce …

Inappropriate payments by insurance organizations or third party payers occur because of
errors, abuse and fraud. The scale of this problem is large enough to make it a priority issue …

Insurance companies have focused on medicare fraud detection to reduce financial losses
and reputational harm because medicare fraud causes tens of billions of dollars in damage …

Detecting fraudulent and abusive cases in healthcare is one of the most challenging
problems for data mining studies. However, most of the existing studies have a shortage of …

Health care insurance fraud is a pressing problem, causing substantial and increasing costs
in medical insurance programs. Due to large amounts of claims submitted, estimated at 5 …

Fraud and abuse have led to significant additional expense in the health care system of the
United States. This paper aims to provide a comprehensive survey of the statistical methods …

Supplying a comprehensive overview of healthcare analytics research, Healthcare Data
Analytics provides an understanding of the analytical techniques currently available to solve …

Fraud is an aggravating problem in the health insurance system, causing a substantial
increase in the cost of medical services. Many models have been developed using data …

This paper seeks to present a model for the analysis of suspicious claims data from
healthcare providers with the use of different clustering algorithms, and the application of the …

Health care expenditures constitute a significant portion of governmental budgets. The
percentage of fraud, waste and abuse within that spending has increased over years. This …