The evaluation of trustworthiness to identify health insurance fraud in dentistry.

Artificial Intelligence in Medicine(2017)

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摘要
•The Economist says 10% of health care expenditure ($272 billion) was wasted on fraudulent claims in 2012.•Previous studies aimed at other types of fraud are inadequate for solving cross-dentist health insurance fraud.•We devise a social-network-based risk evaluation to detect fraudulent claims in dentistry.•By experiment, using real-world or artificial data, our method can effectively identify undetected frauds in the past in dentistry claims data.•Integrating our method with previous research can provide higher accuracy.
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关键词
Fraud identification,Social network,Trustworthiness evaluation,Dentistry
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