Integrated web services platform for the facilitation of fraud detection in health care e-government services

摘要

Public healthcare is a basic service provided by governments to citizens which is increasingly coming under pressure as the European population ages and the ratio of working to elderly persons falls. A way to make public spending on healthcare more efficient is to ensure that the money is spent on legitimate causes. This paper presents the work of the iWebCare project where a flexible, on-line, fraud detection, web services platform was designed and developed. It aims to help those in the Healthcare business, minimize the loss of funds to fraud. The Platform is able to detect erroneous or suspicious records in submitted health care data sets, ensuring homogeneity and consistency and promoting awareness and harmonization of fraud detection practices across health care systems in the EU. Critical objectives included, the development of an ontology of health care data associated with semantic rules, implementation and initial population of an ontology and rules repository, development of a fraud detection engine and implementation of a data mining module. The potential impact of this work can be substantial. More money on healthcare mean better healthcare. Living conditions and the trust of citizens in public healthcare will be improved. ©2009 IEEE.