National Changhua University of Education Institutional Repository : Item 987654321/15880
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题名: A Process-Mining Framework for the Detection of Healthcare Fraud and Abuse
作者: Yang, Wan-Shiou;Hwang, San-Yih
贡献者: 資訊管理學系
关键词: Healthcare fraud;Healthcare abuse;Clinical pathways;Classification model;Data mining
日期: 2006-07
上传时间: 2013-03-27T06:47:50Z
出版者: Elsevier
摘要: 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.
關聯: Expert Systems with Applications, 31(1): 56-68
显示于类别:[資訊管理學系所] 期刊論文

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