Graph Analysis for Detecting Fraud, Waste, and Abuse in Healthcare Data

  title={Graph Analysis for Detecting Fraud, Waste, and Abuse in Healthcare Data},
  author={Juan Liu and Eric A. Bier and Aaron Wilson and John Alexis Guerra G{\'o}mez and Tomonori Honda and Kumar Sricharan and Leilani Gilpin and Daniel Davies},
  booktitle={AI Mag.},
Detection of fraud, waste, and abuse (FWA) is an important yet difficult problem. In this paper, we describe a system to detect suspicious activities in large healthcare claims datasets. Each healthcare dataset is viewed as a heterogeneous network of patients, doctors, pharmacies, and other entities. These networks can be large, with millions of patients, hundreds of thousands of doctors, and tens of thousands of pharmacies, for example. Graph analysis techniques are developed to find… Expand
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