Unsupervised Machine Learning for Explainable Medicare Fraud Detection. (arXiv:2211.02927v2 [cs.CY] UPDATED)

The US federal government spends more than a trillion dollars per year on
health care, largely provided by private third parties and reimbursed by the
government. A major concern in this system is overbilling, waste and fraud by
providers, who face incentives to misreport on their claims in order to receive
higher payments. In this paper, we develop novel machine learning tools to
identify providers that overbill Medicare, the US federal health insurance
program for elderly adults and the disabled. …

detection fraud fraud detection machine machine learning medicare