Weighted risk models for dynamic healthcare fraud detection

Alyssa J. Rolfe

Risk Management and Insurance Review, 2021, vol. 24, issue 2, 143-150

Abstract: Despite efforts to prevent it, fraud in the United States healthcare system remains a serious and pressing issue. Since healthcare fraud is a complex and multi‐faceted problem, fraud‐fighting solutions must be flexible enough to address the ever‐evolving nature of the crime. Here, we present a method to identify healthcare fraud in such a manner that incorporates both potential fraud as well as risky provider behavior. The proposed weighted risk model provides a framework for creating a dynamic fraud detection database that can be easily scaled up to incorporate emerging fraud schemes.

Date: 2021
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https://doi.org/10.1111/rmir.12183

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Persistent link: https://EconPapers.repec.org/RePEc:bla:rmgtin:v:24:y:2021:i:2:p:143-150

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