Outlier detection in healthcare fraud: A case study in the Medicaid dental domain

• Published in: International journal of accounting information systems Vol. 21; pp. 18 - 31
• Main Authors: van Capelleveen, Guido, Poel, Mannes, Mueller, Roland M., Thornton, Dallas, van Hillegersberg, Jos
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 01.06.2016; Elsevier Science Publishing Company, Inc
• Subjects: Algorithms; Automation; Decision support; Dental care; Fraud; Insurance claims; Insurance fraud; Medicaid; Medical fraud detection; Outlier detection; Studies; Outlier detection; Medical fraud detection; Decision support

Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. Due to large amounts of claims submitted, estimated at 5 billion per day, review of individual claims or providers is a difficult task. This encourages the employment of automat...