Dallas Thornton

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It is estimated that approximately $700 billion is lost due to fraud, waste, and abuse in the US healthcare system. Medicaid has been particularly susceptible target for fraud in recent years, with a distributed management model, limited cross-program communications, and a difficult-to-track patient population of low-income adults, their children, and(More)
It is estimated that between $600 and $850 billion annually is lost to fraud, waste, and abuse in the US healthcare system, with $125 to $175 billion of this due to fraudulent activity (Kelley 2009). Medicaid, a state-run, federally-matched government program which accounts for roughly one-quarter of all healthcare expenses in the US, has been particularly(More)
This paper describes an effective method of outlier based predictors for health insurance fraud detection that identifies suspicious behavior of health care providers. Fraud and abuse on medical claims became a major concern for health insurance companies last decades. Estimates made for the studied U.S. Medicaid health insurance program is that up to 10%(More)
Fraud, waste, and abuse in the U.S. healthcare system are estimated at $700 billion annually. Predictive analytics offers government and private payers the opportunity to identify and prevent or recover such billings. This paper proposes a data-driven method for fraud detection based on comparative research, fraud cases, and literature review. Unsupervised(More)
EDUCAUSE is a nonprofit association whose mission is to advance higher education by promoting the intelligent use of information technology. The mission of the EDUCAUSE Center for Applied Research is to foster better decision making by conducting and disseminating research and analysis about the role and implications of information technology in higher(More)
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