A Heuristic Approach To Predict False Claims in Health Care Sectors

A Heuristic Approach To Predict False Claims in Health Care Sectors

Registration ID: IJNRD_170045

Published ID: IJNRD1705024

DOI: Click Here to Get

Komal Survase , Manisha Sangshetty , Rajani Waghire , Smita Pawar , P. B. Jawalkar

Protocol Collection,C Means Clustering, Hidden Markov Model, Fuzzy Classification.

Due to happening of health care fraud there is huge loss for companies. To overcome this problem some systems need to implement to identify fraud. To detect health care fraud many systems uses synthesized datasets, data mining techniques and hybrid approach. There are many health care fraud detection systems are available i) Survey on Hybrid Approach for Fraud Detection in Health Insurance, ii) Data Mining for Fraud Detection, iii) A survey on statistical methods for health care fraud detection. Many systems related to health care fraud are having performance issues regarding detection of fraud, so this paper proposes an idea of health care fraud detection. To enhance the process of fraud claims detection of the doctors at the insurance company’s end proposed method put forwards an idea of identifying fraud claims by clustering the claims based on the protocols by using the C-means clustering technique which is then powered with Hidden markov model to extract the fraud list and this process is catalyzed by fuzzy logic classification theory.

Published Paper   E-Certificate

"A Heuristic Approach To Predict False Claims in Health Care Sectors", IJNRD - INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT (www.IJNRD.org), ISSN:2456-4184, Vol.2, Issue 5, page no.112-114, May-2017, Available :https://ijnrd.org/papers/IJNRD1705024.pdf

Volume 2 Issue 5, May-2017

Pages : 112-114

Paper Reg. ID: IJNRD_170045

Published Paper Id: IJNRD1705024

Downloads: 000121125

Research Area: Engineering

Country: Pune, Maharashtra, India

Published Paper PDF: https://ijnrd.org/papers/IJNRD1705024.pdf

Published Paper URL: https://ijnrd.org/viewpaperforall?paper=IJNRD1705024

Journal Name: INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT(IJNRD)

ISSN: 2456-4184 | IMPACT FACTOR: 8.76 Calculated By Google Scholar | ESTD YEAR: 2016

An International Scholarly Open Access Journal, Peer-Reviewed, Refereed Journal Impact Factor 8.76 Calculate by Google Scholar and Semantic Scholar | AI-Powered Research Tool, Multidisciplinary, Monthly, Multilanguage Journal Indexing in All Major Database & Metadata, Citation Generator

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This work is licensed under a Creative Commons Attribution 4.0 International License and The Open Definition

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