Identifying frauds and anomalies in Medicare-B dataset.

Abstract

Healthcare industry is growing at a rapid rate to reach a market value of $7 trillion dollars world wide. At the same time, fraud in healthcare is becoming a serious problem, amounting to 5% of the total healthcare spending, or $100 billion dollars each year in US. Manually detecting healthcare fraud requires much effort. Recently, machine learning and data mining techniques are applied to automatically detect healthcare frauds. This paper proposes a novel PageRank-based algorithm to detect healthcare frauds and anomalies. We apply the algorithm to Medicare-B dataset, a real-life data with 10 million healthcare insurance claims. The algorithm successfully identifies tens of previously unreported anomalies.