A comprehensive analysis on how data analysis helps combat

Decisive Markets Insights has released a new report on healthcare market fraud detection. It is more common among medical providers and generally leads to increased health care costs, insurance premiums and taxes for the general public. The misuse of medical insurance systems by providers, doctors, and beneficiaries leads to healthcare fraud in the healthcare industry, and detecting fraud manually is a difficult task. Insurance companies can use the likelihood of healthcare fraud to prevent or reduce losses by taking quick action.

According to research manager Sunil Kumar Chhabra of Decisive Markets Insights, healthcare professionals, patients and other parties who knowingly deceive the healthcare system in order to obtain illegal benefits or payments can all be responsible for fraud. digital and cybernetics of healthcare. The above verdict is derived from careful strategic market research by Sunil Chabra.

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Here are some of the most common ways used by medical providers to mislead patients/insurance providers through claims procedures:
• Invoicing of services not provided
• Make duplicate requests.
• Falsification of patient or claim data
• Present unauthorized services as authorized services.
• Use of incorrect codes for diagnosis or treatment.
• Taking a health insurance number or card and using it to make false claims.

Since 1980, the United States has experienced a significant increase in health care spending. The healthcare sector is the main target of fraud due to its size and the huge amount of money involved. Therefore, a key factor in reducing the cost of healthcare services is effective fraud detection. Many researchers have worked to create sophisticated anti-fraud strategies incorporating data mining, machine learning, or other techniques in an effort to achieve more accurate fraud detection.

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Use of technologies for the detection and prevention of fraud in healthcare
Traditional approaches to detecting healthcare fraud have not been successful. Detecting healthcare fraud also requires tedious investigative work after submitting false claims. Detecting fraud before claims are paid is a more effective way to prevent it.

Through data-driven innovation, including computing, data mining, machine learning, analytics and other types of artificial intelligence (AI), the development of various mechanisms, Fraud detection and prevention technologies have advanced considerably.

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This press release was published on openPR.

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