A process-mining framework for the detection of healthcare fraud and abuse

@article{Yang2006APF,
  title={A process-mining framework for the detection of healthcare fraud and abuse},
  author={Wan-Shiou Yang and San-Yih Hwang},
  journal={Expert Syst. Appl.},
  year={2006},
  volume={31},
  pages={56-68}
}
People rely on government-managed health insurance systems, private health insurance systems, or both to share the expensive healthcare costs. With such an intensive need for health insurances, however, health care service providers’ fraudulent and abusive behavior has become a serious problem. In this research, we propose a data-mining framework that utilizes the concept of clinical pathways to facilitate automatic and systematic construction of an adaptable and extensible detection model. The… CONTINUE READING
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References

Publications referenced by this paper.
Showing 1-10 of 31 references

A data mining technique combining fuzzy sets theory and Bayesian classifier—An application of auditing the health insurance fee

  • C. L. Chan, C. H. Lan
  • Proceedings of the international conference on…
  • 2001
Highly Influential
7 Excerpts

A fuzzy system for detecting anomalous behaviors in healthcare provider claims

  • E. Cox
  • Intelligent system for finance and business (pp…
  • 1995
Highly Influential
3 Excerpts

Health care fraud: A serious and costly reality for all Americans

  • Health care fraud
  • National Health Care Anti-Fraud Association…
  • 2002
1 Excerpt

Mining frequent temporal patterns in process databases

  • C. P. Wei, S. Y. Hwang, W. S. Yang
  • Proceedings of international workshop on…
  • 2000
1 Excerpt

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