A Fraud Resilient Medical Insurance Claim System
Yuliang Shi, Chenfei Sun, Qingzhong Li, Lizhen Cui, Han Yu, Chunyan Miao · Proceedings of the AAAI Conference on Artificial Intelligence · 2016
As many countries in the world start to experience population aging, there are an increasing number of people relying on medical insurance to access healthcare resources. Medical insurance frauds are causing billions of dollars in losses for public healthcare funds. The detection of medical insurance frauds is an important and difficult challenge for the artificial intelligence (AI) research community. This paper outlines HFDA, a hybrid AI approach to effectively and efficiently identify fraudulent medical insurance claims which has been tested in an online medical insurance claim system in China.