Fraud Detection
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Machine learning presents a solid opportunity for the industry and regulators to fight back against fraudsters. By automatically combining hundreds of variables from different datasets, including patient/prescriber history, interaction graphs, prescription characteristics, and other contextual data, it became possible to target actual fraud cases.
Benefits for the company
Insurance fraud is a major issue that drives up healthcare costs up for insurers, providers, taxpayers and patients.
Feasability
High
Type of expertise/ AI domain
Anomaly Detection
Internal data required
Patient’s History, interaction, Prescription, etc
Machine Learning can easily detect fraud claims more effectively.