Medical Insurance Fraud Detection Based on Block Chain and Machine Learning Approach
Bijaya Kumar Sethi, Prakash Kumar Sarangi, Adepu Sai Aashrith · 2022
With the significant rise in medical costs, the Health Insurance Department's duty of controlling medical expenses has become increasingly vital. Traditional medical insurance settlements are paid per-service, which results in a lot of unnecessary costs. Now a day, the single-disease payment mechanism has been frequently employed to address this issue. However, there is a possibility of fraud with single-disease payments. In this work, the authors have presented a methodology for detecting the health insurance fraud entrenched block chain and Machine learning techniques like Support Vector Machine (SVM) and logistic Regression, that can automatically recognize apprehensive medical records to assure sustainable execution of single-disease payment and reduce medical insurance worker's workload. The authors have also proposed a medical record storage and management procedure based on consortium block chain to assure data security, immutability, traceability, and audit ability. The suggested system may effectively identify fraud and considerably increase the efficiency of medical insurance evaluations, as demonstrated by experiments on two real datasets from two 3A hospitals.