Detecting Fraud in Health Insurance Data: Learning to Model Incomplete Benford's Law Distributions
نویسندگان
چکیده
Benford’s Law [1] specifies the probabilistic distribution of digits for many commonly occurring phenomena, ideally when we have complete data of the phenomena. We enhance this digital analysis technique with an unsupervised learning method to handle situations where data is incomplete. We apply this method to the detection of fraud and abuse in health insurance claims using real health insurance data. We demonstrate improved precision over the traditional Benford approach in detecting anomalous data indicative of fraud and illustrate some of the challenges to the analysis of healthcare claims fraud.
منابع مشابه
Adaptive Fraud Detection Using Benford's Law
Adaptive Benford’s Law [1] is a digital analysis technique that specifies the probabilistic distribution of digits for many commonly occurring phenomena, even for incomplete data records. We combine this digital analysis technique with a reinforcement learning technique to create a new fraud discovery approach. When applied to records of naturally occurring phenomena, our adaptive fraud detecti...
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