HEALTHCARE SERVICE PROVIDER INSURANCE CLAIM FRAUD AND ERROR DETECTION USING CO-OCCURRENCE

摘要

Data characterizing one or more healthcare insurance claims is received. Each claim comprises variables characterizing aspects of a healthcare service for which reimbursement is sought. The healthcare services being initiated by a single healthcare service provider for a single patient. Thereafter, score variables from the variables of the healthcare insurance claims are generated. Based on these score variables, it is determined whether a presence of one or more of the variables in more than one of the healthcare insurance claims is indicative of fraud or error based on levels of co-occurrence of the one or more pairs of variables in historical healthcare insurance claims being initiated by a single healthcare service provider. Subsequently, notification that the one or more of the healthcare insurance claims are indicative of fraud based on a positive determination is initiated (to allow, for example, a user to manually review the healthcare insurance claims, etc.). Related techniques, apparatus, systems, and articles are also described.