A survey on statistical methods for health care fraud detection

A survey on statistical methods for health care fraud detection

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Article ID: iaor200914194
Country: Netherlands
Volume: 11
Issue: 3
Start Page Number: 275
End Page Number: 287
Publication Date: Sep 2008
Journal: Health Care Management Science
Authors: , , ,
Keywords: fraud
Abstract:

Fraud and abuse have led to significant additional expense in the health care system of the United States. This paper aims to provide a comprehensive survey of the statistical methods applied to health care fraud detection, with focuses on classifying fraudulent behaviors, identifying the major sources and characteristics of the data based on which fraud detection has been conducted, discussing the key steps in data preprocessing, as well as summarizing, categorizing, and comparing statistical fraud detection methods. Based on this survey, some discussion is provided about what has been lacking or under–addressed in the existing research, with the purpose of pinpointing some future research directions.

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