Medical Knowledge Graph to Enhance Fraud, Waste, and Abuse Detection on Claim Data: Model Development and Performance Evaluation

BACKGROUND: Fraud, Waste, and Abuse (FWA) detection is a significant yet challenging problem in the health insurance industry. An essential step in FWA detection is to check whether the medication is clinically reasonable with respect to the diagnosis. Currently, human experts with sufficient medica...

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Detalles Bibliográficos
Autores principales: Sun, Haixia, Xiao, Jin, Zhu, Wei, He, Yilong, Zhang, Sheng, Xu, Xiaowei, Hou, Li, Li, Jiao, Ni, Yuan, Xie, Guotong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2020
Materias:
Original Paper
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413281/
https://www.ncbi.nlm.nih.gov/pubmed/32706714
http://dx.doi.org/10.2196/17653

Internet

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413281/
https://www.ncbi.nlm.nih.gov/pubmed/32706714
http://dx.doi.org/10.2196/17653

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