Researchers’ Work from University of Louisiana Lafayette Focuses on Insurance (Identification of Fraudulent Healthcare Claims Using Fuzzy Bipartite Knowledge Graphs): Insurance

Health Policy and Law Daily

2024 FEB 15 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- Research findings on Insurance are discussed in a new report. According to news reporting from Lafayette, Louisiana, by NewsRx journalists, research stated, “Health insurance is one of the most important services that people depend on for paying the bills related to hospital and clinical services. This dependency on health insurance lures some healthcare service providers to commit insurance frauds which has become a grave concern.”

The news correspondents obtained a quote from the research from the University of Louisiana Lafayette, “The majority of healthcare fraud is committed by a very small number of untrustworthy providers. Yet, such fraudulent actions damage the reputation of the health service providers and cost the system billions of dollars. In this article, we specifically focus on the fraudulent claim identification problem and develop different solution schemes to identify the fraudulent cases in healthcare claims with minimal data. We present a solution to the fraudulent claim identification problem that translates diagnoses and procedure code’s relations into Bipartite Graphs with Fuzzy Edges (BiGFuzzE). We also investigate the extension of BiGFuzzE using vector representations of clinical codes instead of non-negative matrix factorization (NMF).”

According to the news reporters, the research concluded: “Our experimental evaluations demonstrate significant outcomes.”

This research has been peer-reviewed.

For more information on this research see: Identification of Fraudulent Healthcare Claims Using Fuzzy Bipartite Knowledge Graphs. IEEE Transactions on Services Computing, 2023;16(6):3931-3945. 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)

Our news journalists 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.2023.3296782. 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.