Enhancing healthcare data integrity: fraud detection using unsupervised learning techniques

Abstract

Data in healthcare forms the backbone of any treatment and decision-making for patients. However, the data from a healthcare institution can sometimes be prone to abnormalities, thereby putting treatment and patient safety in jeopardy. This paper points to the dire need for reliable anomaly detection systems in the healthcare industry. It employs various unsupervised learning methods, including Isolation Forest, Local Outlier Factor (LOF), K-Nearest Neighbours (KNN), and autoencoder models for detecting abnormalities in healthcare data with better accuracy. Anomaly detection capabilities also allow health providers to reduce risks and provide some assurance of the integrity of the data, as these capabilities are more likely to indicate unusual patient profiles or incorrect test results. Isolation Forest, LOF, and KNN are the preliminary methods for performing anomaly detection in this work, with Isolation Forest yielding the best results. Then, autoencoder models that learn subtle variations and complex patterns in data are employed. This paper seeks to enhance anomaly detection in terms of accuracy and reliability to ensure better healthcare data quality and patient safety.