• P-ISSN 0974-6846 E-ISSN 0974-5645

Indian Journal of Science and Technology


Indian Journal of Science and Technology

Year: 2016, Volume: 9, Issue: 43, Pages: 1-6

Original Article

Distance based Model to Detect Healthcare Insurance Fraud within Unsupervised Database


Objectives: Healthcare fraud costs the country tens of billions of dollars a year. Methods: Fraudulent behaviors of healthcare providers and patients have become a serious burden to insurance systems by bringing unnecessary costs. Insurance companies thus developed methods to identify fraud. Results: In this paper a methodology offered based on data mining approach to discover fraud in healthcare insurance. Applications: To test and evaluate model real-world data set related to healthcare insurance in Iran has been used. Investment result of operation model on this data set indicates proper performance of it. 

Keywords: Anomaly Detection, Data Mining, Healthcare Fraud, Outlier Detection, Unsupervised Method


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