Categorizing and Describing the Types of Fraud in Healthcare

Dallas Thornton*, Michel Brinkhuis, Chintan Amrit, Robin Aly

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)
116 Downloads (Pure)

Abstract

Today, the over $2 trillion US healthcare system is ravaged by fraud, waste, and abuse, with an estimated one-third of all these costs frivolously spent in such ways. Sun Tzu wrote, "Every battle is won or lost before it's ever fought." To combat healthcare fraud, we must understand it and the forms it takes. In this paper, we systematically evaluate published literature using Webster and Watson's concept matrix technique. From the applicable published literature, we provide a categorization and description of the documented types of fraud in healthcare.

Original languageEnglish
Pages (from-to)713-720
Number of pages8
JournalProcedia computer science
Volume64
DOIs
Publication statusPublished - 2015

Keywords

  • data mining
  • fee-for-service
  • fraud
  • health
  • healthcare
  • insurance
  • managed care
  • Medicaid
  • medical
  • Medicare

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