Tag Archives: How Machine Learning can Prevent Healthcare Fraud

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.

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