Data driven implementation to filter fraudulent medicaid applications

There has been much work to improve current IT Healthcare system to manage and maintain health records. The U.S government is trying to integrate different type of healthcare data to provide a centralized system for healthcare service providers and patients. However, less attention is paid to implem...

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Bibliographic Details
Main Authors: Suleiman, Muhammad, Agrawal, Rajeev, Seay, Cameron, Grosky, William
Format: Conference Proceeding
Language:English
Subjects:
Computer architecture
Data Driven
Data mining
Fraud Detection
Government
Healthcare
Heterogenous Database
Medical services
Mediciad
Scoring Model
Vehicles
Online Access:Request full text
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Summary:There has been much work to improve current IT Healthcare system to manage and maintain health records. The U.S government is trying to integrate different type of healthcare data to provide a centralized system for healthcare service providers and patients. However, less attention is paid to implement a system to detect fraudulent application, specifically in Medicaid. In this paper, we propose a data driven implementation using a layered architecture to filter fraudulent applications for Medicaid. In this system, we utilize a set of public and private databases which contain asset records of an individual. These asset records are used to determine the Medicaid eligibility of an applicant.
ISSN:1091-0050
1558-058X
DOI:10.1109/SECON.2014.6950652