Fraud detection for healthcare

Details

2013 August 11; Chicago, IL

Speakers

Hoda Eldardiry
Liu, Juan J.
Zhang, Ying
Fromherz, Markus P. J.
Event

Fraud detection for healthcare

Fraud detection in healthcare is an important yet difficult problem. We present a fraud screening solution to identify suspicious pharmacies from a large dataset of pharmacy claims. Our solution has stemmed from collaboration with medical claim investigators and proven usefulness to investigators by discovering real fraud cases. We focus on a concrete problem of probabilistic outlier detection from a feature set designed for pharmacy claims. Although the reported results are specific to pharmacy claims, this work is not restricted to pharmacy claims. We are currently extending the solution to fraud screening of more general medical claims and fraud detection in other verticals.

Additional information

Focus Areas

Our work is centered around a series of Focus Areas that we believe are the future of science and technology.

FIND OUT MORE
Licensing & Commercialization Opportunities

We’re continually developing new technologies, many of which are available for¬†Commercialization.

FIND OUT MORE
News

PARC scientists and staffers are active members and contributors to the science and technology communities.

FIND OUT MORE