Centro de Documentacion de Fundación MAPFRE - Weighted risk models for dynamic healthcare fraud detection

MAP20210024320

Weighted risk models for dynamic healthcare fraud detection / Alyssa J. Rolfe

Sumario: Despite efforts to prevent it, fraud in the United States healthcare system remains a serious and pressing issue. Since healthcare fraud is a complex and multi-faceted problem, fraud-fighting solutions must be flexible enough to address the ever-evolving nature of the crime. Here, we present a method to identify healthcare fraud in such a manner that incorporates both potential fraud as well as risky provider behavior. The proposed weighted risk model provides a framework for creating a dynamic fraud detection database that can be easily scaled up to incorporate emerging fraud schemes

En: Risk management & insurance review. - Malden, MA : The American Risk and Insurance Association by Blackwell Publishing, 1999- = ISSN 1098-1616. - 03/05/2021 Tomo 24 Número 2 - 2021 , p. 143-150

1. Salud . 2. Medicina . 3. Fraude . 4. Riesgo . 5. Fraude en el seguro . 6. Análisis de riesgos . 7. Estados Unidos . I. Título.