Unsupervised DRG Upcoding Detection in Healthcare Databases

Abstract

Diagnosis Related Group (DRG) upcoding is an anomaly in healthcare data that costs hundreds of millions of dollars in many developed countries. DRG upcoding is typically detected through resource intensive auditing. As supervised modeling of DRG upcoding is severely constrained by scope and timeliness of past audit data, we propose in this paper an… (More)
DOI: 10.1109/ICDMW.2010.108

Topics

10 Figures and Tables

Slides referencing similar topics