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Detecting health care claims fraud | SAS

    https://www.sas.com/en_us/insights/articles/risk-fraud/detect-health-care-claims-fraud.html
    Several years ago, the US Department of Justice announced that a Florida urologist would pay more than $3.8 million for ordering unnecessary medical tests – more than 13,000 urinalysis tests that are only applicable to certain cases related to bladder cancer. The …

The key to detecting fraud and abuse in medical …

    https://cdn-aem.optum.com/content/dam/optum3/optum/en/resources/white-papers/Key_Detecting_Fraud_wp_12_2012.pdf
    The key to detecting fraud and abuse in medical billing There is a similar spectrum of disease severity and treatment intensity within each hospital catchment area, home …

How to Spot Health Fraud | FDA

    https://www.fda.gov/drugs/bioterrorism-and-drug-preparedness/how-spot-health-fraud
    The following products typify three fraudulent products whose claims prompted FDA to issue warning letters to the products' marketers, notifying them that their products …

The Challenge of Health Care Fraud – NHCAA

    https://www.nhcaa.org/tools-insights/about-health-care-fraud/the-challenge-of-health-care-fraud/
    The National Health Care Anti-Fraud Association (NHCAA) estimates that the financial losses due to health care fraud are in the tens of billions of dollars each year. A …

What To Know About Medical Identity Theft | Consumer …

    https://consumer.ftc.gov/articles/what-know-about-medical-identity-theft

    Health Care Fraud — FBI - Federal Bureau of Investigation

      https://www.fbi.gov/investigate/white-collar-crime/health-care-fraud
      Health care fraud can be committed by medical providers, patients, and others who intentionally deceive the health care system to receive unlawful benefits or payments. The FBI is the primary...

    Fraud & Abuse Laws - U.S. Department of Health and …

      https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/
      Fraud & Abuse Laws The five most important Federal fraud and abuse laws that apply to physicians are the False Claims Act (FCA), the Anti-Kickback Statute (AKS), the …

    Fraud Detection in Healthcare - Towards Data Science

      https://towardsdatascience.com/fraud-detection-in-healthcare-1801bf19d36c
      Even if we keep opioids aside, the sheer volume of fraudulent claims is huge. However, it should be mentioned that what we generally call fraud, is in fact, Fraud, Waste and Abuse (FWA). While …

    Insurance Claims Investigations: Detecting Fraud and …

      https://www.i-sight.com/resources/insurance-claims-investigations-detecting-fraud-and-abuse/
      The Coalition Against Insurance Fraud estimates that illegitimate insurance claims cost about $80 billion every year and that 10 per cent of people think that …

    Applications of Data Mining in Detecting Fraudulent Health …

      https://www.ijert.org/applications-of-data-mining-in-detecting-fraudulent-health-insurance-claim
      To detect fraudulent claims we use two types of data mining techniques viz., supervised and unsupervised. Both the techniques have their own positives and …



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