A Model System to Identify Health Care Frauds

Volume: 4    Issue: 1

Year of Publication: 2017

Pages: (10-13)

Authors: Rupali Gorad, Archana Augustine

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Abstract

As the human life march 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 suffer 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 tiny step towards this the proposed system develops a web application panel for both the doctors and insurance companies to identify the fraud claims of the doctors at insurance company’s end using Hidden markov model which is powered with fuzzy classification.

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Keywords

Clustering algorithms, Matrix converters, Detection algorithms, Insurance, Algorithm design and analysis