It is estimated that approximately 10% of healthcare system expenditures are wasted due to
medical fraud and abuse. In the medical area, the combination of thousands of drugs and …

Objective The huge loss of health insurance funds has been a topic of concern around the
world. This study aims to explore the network of moral hazard activities and the attribution …

The paper presents a novel methodology based on machine learning to optimize medical
benefits in healthcare settings, ie, corporate, private, public or statutory. The optimization is …

Healthcare insurance fraud is a complex and costly problem that has become a concern
globally. Traditional methods of detecting fraudulent claims and requests are time …

The National Health Insurance program started running in Indonesia on January 1, 2014.
Along with the increasing number of National Health Insurance participants and health …

Background Healthcare programs and insurance initiatives play a crucial role in ensuring
that people have access to medical care. There are many benefits of healthcare insurance …

Detection rates of non-compliant activity in Australian provider medical claims are below
international benchmarks, and new methods are required. Since the Department of Health …

The so-called" dark web" has emerged as the most trustworthy platform for thieves to launch
their enterprises. The healthcare industry has become a haven for illegal activities such as …

The aim of the study was to explore the machine learning and artificial intelligence algorithm
needed to detect healthcare financial statement anomalies. Traditional fraud detection …

The integration of artificial intelligence (AI) and machine learning (ML) into risk management
and fraud detection within the financial sector marks a significant evolution in combating …