Recent Findings from University of Louisiana Lafayette Provides New Insights into Insurance (Identifying Health Insurance Claim Frauds Using Mixture of Clinical Concepts): Insurance

Health Policy and Law Daily

2022 SEP 09 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- New research on Insurance is the subject of a report. According to news reporting originating from Lafayette, Louisiana, by NewsRx correspondents, research stated, “Patients depend on health insurance provided by the government systems, private systems, or both to utilize the high-priced healthcare expenses. This dependency on health insurance draws some healthcare service providers to commit insurance frauds.”

Our news editors obtained a quote from the research from the University of Louisiana Lafayette, “Although the number of such service providers is small, it is reported that the insurance providers lose billions of dollars every year due to frauds. In this article, we formulate the fraud detection problem over a minimal, definitive claim data consisting of medical diagnosis and procedure codes. We present a solution to the fraudulent claim detection problem using a novel representation learning approach, which translates diagnosis and procedure codes into Mixtures of Clinical Codes (MCC). We also investigate extensions of MCC using Long Short Term Memory networks and Robust Principal Component Analysis.”

According to the news editors, the research concluded: “Our experimental results demonstrate promising outcomes in identifying fraudulent records.”

This research has been peer-reviewed.

For more information on this research see: Identifying Health Insurance Claim Frauds Using Mixture of Clinical Concepts. IEEE Transactions on Services Computing, 2022;15(4):1-1. IEEE Transactions on Services Computing can be contacted at: Ieee Computer Soc, 10662 Los Vaqueros Circle, PO Box 3014, Los Alamitos, CA 90720-1314, USA. (Institute of Electrical and Electronics Engineers - http://www.ieee.org/; IEEE Transactions on Services Computing - http://ieeexplore.ieee.org/xpl/RecentIssue.jsp?punumber=4629386)

The news editors report that additional information may be obtained by contacting Md Enamul Haque, University of Louisiana Lafayette, School of Computing and Information, Lafayette, LA 70503, United States.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1109/tsc.2021.3051165. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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