Unsupervised DRG Upcoding Detection in Healthcare Databases


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


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