期刊名称：International Journal of Innovative Research in Computer and Communication Engineering
印刷版ISSN：2320-9798
电子版ISSN：2320-9801
出版年度：2017
卷号：5
期号：5
页码：9553
DOI：10.15680/IJIRCCE.2017.0505146
出版社：S&S Publications
摘要：The revolutionary health care policy concept facilitates all the patients irrespective of any caste andcreed to avail the best services of the doctors for their diseases. Many of the health care insurance companies providethis facility for the people, But to detect whether the claims are genuine or fraud remains a challenge. Due to thehappening of health care frauds, companies are incurring the immense loss. To overcome this problem, some systemneeds to identify the fraud. Many systems exist to deal with these kinds of fraud health insurance claims from thedoctors, but most of them are not up to the mark to identify the proper fraud detection operand. Frauds are verycommon but due to a large amount of data and lack of technology available, many systems related to Health Care frauddetection are having performance issues regarding detection of frauds.So as a small step towards this, the proposed system will develop a framework for both the doctors and insurancecompanies to identify the fraud claims of the doctors at the insurance company’s end using data mining algorithms withfuzzy classification.
关键词：Health Care fraud; Clustering; Fuzzy Logic;Hidden Markov Model
