Future Internet Applications in Healthcare: Big Data-Driven Fraud Detection with Machine Learning

Konstantinos P. Fourkiotis and Athanasios Tsadiras ()
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Konstantinos P. Fourkiotis: School of Economics, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
Athanasios Tsadiras: School of Economics, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece

Future Internet, 2025, vol. 17, issue 10, 1-24

Abstract: Hospital fraud detection has often relied on periodic audits that miss evolving, internet-mediated patterns in electronic claims. An artificial intelligence and machine learning pipeline is being developed that is leakage-safe, imbalance aware, and aligned with operational capacity for large healthcare datasets. The preprocessing stack integrates four tables, engineers 13 features, applies imputation, categorical encoding, Power transformation, Boruta selection, and denoising autoencoder representations, with class balancing via SMOTE-ENN evaluated inside cross-validation folds. Eight algorithms are compared under a fraud-oriented composite productivity index that weighs recall, precision, MCC, F1, ROC-AUC, and G-Mean, with per-fold threshold calibration and explicit reporting of Type I and Type II errors. Multilayer perceptron attains the highest composite index, while CatBoost offers the strongest control of false positives with high accuracy. SMOTE-ENN provides limited gains once representations regularize class geometry. The calibrated scores support prepayment triage, postpayment audit, and provider-level profiling, linking alert volume to expected recovery and protecting investigator workload. Situated in the Future Internet context, this work targets internet-mediated claim flows and web-accessible provider registries. Governance procedures for drift monitoring, fairness assessment, and change control complete an internet-ready deployment path. The results indicate that disciplined preprocessing and evaluation, more than classifier choice alone, translate AI improvements into measurable economic value and sustainable fraud prevention in digital health ecosystems.

Keywords: artificial intelligence; machine learning; healthcare fraud detection; hospital claims; imbalanced data; threshold calibration; model governance (search for similar items in EconPapers)
JEL-codes: O3 (search for similar items in EconPapers)
Date: 2025
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