The evaluation of trustworthiness to identify health insurance fraud in dentistry
作者：
Highlights：
• The Economist says 10% of health care expenditure ($272 billion) was wasted on fraudulent claims in 2012.
• Previous studies aimed at other types of fraud are inadequate for solving cross-dentist health insurance fraud.
• We devise a social-network-based risk evaluation to detect fraudulent claims in dentistry.
• By experiment, using real-world or artificial data, our method can effectively identify undetected frauds in the past in dentistry claims data.
• Integrating our method with previous research can provide higher accuracy.
摘要
•The Economist says 10% of health care expenditure ($272 billion) was wasted on fraudulent claims in 2012.•Previous studies aimed at other types of fraud are inadequate for solving cross-dentist health insurance fraud.•We devise a social-network-based risk evaluation to detect fraudulent claims in dentistry.•By experiment, using real-world or artificial data, our method can effectively identify undetected frauds in the past in dentistry claims data.•Integrating our method with previous research can provide higher accuracy.
论文关键词：Fraud identification,Social network,Trustworthiness evaluation,Dentistry
论文评审过程：Received 11 February 2016, Accepted 10 December 2016, Available online 27 December 2016, Version of Record 7 January 2017.
论文官网地址：https://doi.org/10.1016/j.artmed.2016.12.002
