Payer

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  FraudHacker - Anomaly detection system for medical insurance claims data

  • Published on: November, 2017
  • Daniel Hannah
  • Code Available

  Centre for Medicare and Medicaid Services (CMS) is a governing body in United States that administers the nation's major healthcare program. To detect ...

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  CMS Medicare Fraud Detection

  • Published on: September, 2018
  • Tao Jin
  • Code Available

  Healthcare is a major industry in the U.S. with both private and government run programs. Healthcare fraud is a main problem that causes substantial m ...

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  Healthcare provider fraud detection analysis

  • Published on: October, 2020
  • Rohan Kumar Soni
  • Code Available

  Healthcare fraud is an organized crime which involves peers of providers, physicians, beneficiaries acting together to make fraud claims. Provider fra ...

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  PREDICTING CONFIDENCE SCORE FOR CLAIM TO BE AUTOMATICALLY PROCESSED FOR FRAUD, WASTE AND ABUSE

  • Published on: July, 2019
  • CitiusTech

  The model predicts the confidence score for claim to be automatically processed for being Fraud, Waste and Abuse (FWA). The confidence score allows de ...

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  SUOD - Accelerating Large Scale Unsupervised Heterogeneous Outlier Detection

  • Published on: March, 2021
  • Wen Wang, Yunlong Wang, Jimeng Sun, Zheng Li, Jianing Yang, Changlin Wan, Leman Akoglu, Cheng Cheng, Yue Zhao,...
  • Code Available

  SUOD (Scalable Unsupervised Outlier Detection) is an acceleration framework for large-scale unsupervised heterogeneous outlier detector training and p ...

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  HealthCare Claims : Application for Android

  • Published on: October, 2020
  • Green-io
  • Code Available

  HealthCare Claims is an AI driven FRAUD DETECTOR Android Application created to protect the payer by identifying inconsistencies and potential rule-br ...

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  Sequence embeddings to identify fraudulent cases in healthcare insurance

  • Published on: May, 2019
  • I. Fursov,  A. Zaytsev,  R. Khasyanov,  E. Burnaev,  M. Spindler
  • Code Available

  Fraud leads to substantial costs and losses for companies and clients in the insurance industries hence fraud detection is a key function in these ind ...