Medicare Fraud Detection using Machine Learning

• Author(s): Pranjal Chaudhari ; Pratibha Koli ; Harshada Mali ; Sumit Pawar ; Prof. Manisha Patil
• Paper ID: 1705865
• Page: 650-655
• Published Date: 05-06-2024
• Published In: Iconic Research And Engineering Journals
• Publisher: IRE Journals
• e-ISSN: 2456-8880
• Volume/Issue: Volume 7 Issue 11 May-2024

Abstract

Medicare fraud is a significant issue that poses a threat to the integrity of the medicare system, leading to substantial financial losses and potentially compromising patient care. In response to this challenge, the utilization of machine learning models has emerged as a promising approach for detecting and preventing fraudulent activities within Medicare. This research paper proposes a machine learning approach for detecting fraud among healthcare providers. The approach involves utilizing machine learning algorithms to analyze diverse datasets containing information on billing patterns, patient demographics, service types, and geographic locations. By training the model on labelled data indicating instances of fraud, it learns to identify patterns and anomalies indicative of fraudulent behavior. Key findings from this study include the successful development of a machine learning model capable of accurately detecting healthcare provider fraud. The model demonstrates high precision, recall, and accuracy rates when tested on both training and unseen data, indicating its robustness and effectiveness.

Keywords

Medicare fraud, Machine Learning, Fraud detection, Support Vector Machine, Logistic Regression, LightGBM, Naïve Bayes.

Citations

IRE Journals:
Pranjal Chaudhari , Pratibha Koli , Harshada Mali , Sumit Pawar , Prof. Manisha Patil "Medicare Fraud Detection using Machine Learning" Iconic Research And Engineering Journals Volume 7 Issue 11 2024 Page 650-655

IEEE:
Pranjal Chaudhari , Pratibha Koli , Harshada Mali , Sumit Pawar , Prof. Manisha Patil "Medicare Fraud Detection using Machine Learning" Iconic Research And Engineering Journals, 7(11)