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Detection Healthcare Frauds in Insurance Industry by Healthcare Service Providers

Pannala, Vinay Reddy (2022) Detection Healthcare Frauds in Insurance Industry by Healthcare Service Providers. Masters thesis, Dublin, National College of Ireland.

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The frauds in insurance industry have exponentially increased over the past few years, this frauds claims leads to increase in spending’s on insurance claims for insurance companies. According to the leading insurance companies, the loss in revenues for the organization is about 15%, which might be a potential threat to the insurance companies, so the organizations have to work on this fraud claims to protect the organization from potential risks as well as keeping the trust among the insurance policy holder. Hence the main goal of this project is to identify the frauds in insurance industry which is carried out by the fraud service providers mainly involves the physicians, as these physicians knows the codes for costliest procedures to claim which is impacting the insurance companies thus this leads the insurance companies to increase the premiums. The models implemented were into machine learning and neural network models in which logistic regression outperformed all the machine learning models and auto encoders from neural network models performed well with two hidden layers than the original auto encoder implementation.

Item Type: Thesis (Masters)
Subjects: Q Science > QA Mathematics > Electronic computers. Computer science
T Technology > T Technology (General) > Information Technology > Electronic computers. Computer science
R Medicine > Healthcare Industry
H Social Sciences > HG Finance > Insurance
Q Science > Q Science (General) > Self-organizing systems. Conscious automata > Machine learning
Divisions: School of Computing > Master of Science in Data Analytics
Depositing User: Tamara Malone
Date Deposited: 27 Feb 2023 16:17
Last Modified: 01 Mar 2023 17:56

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