Healthcare fraud is considered a material risk in the Netherlands, and there is a growing effort by insurers to tackle the issue of health insurance fraud given its materiality. This article describes the application of two methods for the detection of potential fraudulent claims in healthcare provider invoices. We analyse a statistical method and a machine learning method that are shown to be effective in fraud detection analysis.
Anomaly analysis and detection in health insurance
ByKendall Carolissen, and Judith Houtepen
1 July 2020
Anomaly analysis and detection in health insurance