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Please use this identifier to cite or link to this item: http://ir.ncue.edu.tw/ir/handle/987654321/15880

Title: A Process-Mining Framework for the Detection of Healthcare Fraud and Abuse
Authors: Yang, Wan-Shiou;Hwang, San-Yih
Contributors: 資訊管理學系
Keywords: Healthcare fraud;Healthcare abuse;Clinical pathways;Classification model;Data mining
Date: 2006-07
Issue Date: 2013-03-27T06:47:50Z
Publisher: Elsevier
Abstract: People rely on government-managed health insurance systems, private health insurance systems, or both to share the expensive healthcare costs. With such an intensive need for health insurances, however, health care service providers’ fraudulent and abusive behavior has become a serious problem. In this research, we propose a data-mining framework that utilizes the concept of clinical pathways to facilitate automatic and systematic construction of an adaptable and extensible detection model. The proposed approaches have been evaluated objectively by a real-world data set gathered from the National Health Insurance (NHI) program in Taiwan. The empirical experiments show that our detection model.
Relation: Expert Systems with Applications, 31(1): 56-68
Appears in Collections:[資訊管理學系所] 期刊論文

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