Researchers teach ‘machines’ to detect Medicare fraud

Like a ‘needle in a haystack,’ human auditors have the painstaking task of manually checking thousands of Medicare claims for specific patterns that could indicate foul play or fraudulent behaviors. Currently, fraud enforcement efforts rely heavily on health care professionals coming forward with information about Medicare fraud. Researchers are the first to use big data from Medicare Part B and employ advanced data analytics and machine learning to automate the fraud detection process.
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