How Machine Learning in Analytics Can Prevent Healthcare Fraud?

How Machine Learning in Analytics Can Prevent Healthcare Fraud?

Posted on December 27, 2018

The healthcare industry is easily one of the biggest industries right now. And it is also a sector where it is very easy and common to lose money. No, we are not talking about insurance companies who give out plans with a lot of writing in small fonts, instead, we are referring to the healthcare providers who practice fraudulent billings to earn profits. In this article, we will first explain how this process works and also how machine learning can pose as a potential solution to this problem.

How does this fraud work?

Medical companies provide insurance options to all of its patients. And while these insurance options are usually supposed to take care of prescribed medication costs, some of the companies send out refills to the patients without them even having applied for it. In this process they allow each prescription to be billed twice, maybe even more, thereby making profits off medication even though the insurance should have covered it.

Once the insurance provider notices that one of their partner healthcare providers is not playing by the rules, they can send in a data team to sift through months of data and find the anomaly, and once found, charges can be pressed.

However, to be able to understand such a delicate fraud which lies within thousands of bills within a short time is practically impossible. Most insurance companies who have discovered such fraudulent healthcare partners are those who have been tipped by the insurance receivers. But waiting for such a disaster to happen and only then taking care of it means a loss for the insurance provider and such losses cannot be tolerated.

How can machine learning help?

The primary purpose of machine learning is to be able to file through huge amounts of data, and with personalized approaches as per the necessities presented by the data and its problems. And if this technology can be used in the field of medical insurance providers, prescription billing fraud and other such delicate frauds would be easily detectable right at the beginning of its occurrence.

Choose Flatworld Solutions for Cost-effective Healthcare Services

Are you an insurance provider looking for machine learning solutions but holding back due to budgetary constraints? Well, we have good news for you! You can now partner with Flatworld Solutions and find professional machine learning solution providers, and the process is bound to be cheaper than the current market rates. Our team comprises some of the most qualified and skilled healthcare professionals who can deliver quality healthcare solutions keeping in mind the latest technologies such as artificial intelligence and machine learning.

If you have a similar requirement, then feel free to get in touch with us today!

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