Concepedia

Provider Fraud Detection

Provider Fraud Detection is a methodological framework within the domain of fraud detection in claims that specifically identifies and prevents fraudulent activities perpetrated by service providers through systematic analysis of billing patterns, service delivery anomalies, and behavioral indicators distinct from those of legitimate providers.

30

Publications

1K

Citations

55

Authors

21

Institutions

Publications per year

2017–2026

16

Parents

Publications

30

Big Data fraud detection using multiple medicare data sources

Matthew Herland, Taghi M. Khoshgoftaar, Richard A. Bauder · Journal Of Big Data · 2018 · 169 citations · Full text

, , +14

Medicare Fraud Detection Using Machine Learning Methods

Richard A. Bauder, Taghi M. Khoshgoftaar · 2017 · 123 citations

, , +13

Medicare Fraud Detection Using Random Forest with Class Imbalanced Big Data

Richard A. Bauder, Taghi M. Khoshgoftaar · 2018 · 71 citations

, , +17

Identifying Medicare Provider Fraud with Unsupervised Machine Learning

Richard A. Bauder, Raquel da Rosa, Taghi M. Khoshgoftaar · 2018 · 52 citations

, , +17

Data mining application to healthcare fraud detection: a two-step unsupervised clustering method for outlier detection with administrative databases

Michela Carlotta Massi, Francesca Ieva, Emanuele Lettieri · BMC Medical Informatics and Decision Making · 2020 · 51 citations · Full text

, , +17

1–5 of 30

Authors

55

  1. TM
    Taghi M. Khoshgoftaar

    Florida Atlantic University, United States

    11 publications · 665 citations

    11

    h-index

  2. RA
    Richard A. Bauder

    Florida Atlantic University, United States

    10 publications · 635 citations

    10

    h-index

  3. MH
    Matthew Herland

    Florida Atlantic University, United States

    2 publications · 190 citations

    2

    h-index

  4. FI
    Francesca Ieva

    Politecnico di Milano, Italy

    2 publications · 69 citations

    2

    h-index

  5. TH
    Tawfiq Hasanin

    Florida Atlantic University, United States

    2 publications · 83 citations

    2

    h-index

1–5 of 55

Institutions

21

  1. Florida Atlantic University

    Boca Raton, United States

    10 h-index

    25 publications

    1.6K citations

  2. Berlin School of Economics and Law

    Berlin, Germany

    1 h-index

    1 publications

    37 citations

  3. Human Technopole

    Milan, Italy

    1 h-index

    2 publications

    102 citations

  4. Carter Center

    Atlanta, United States

    1 h-index

    1 publications

    13 citations

  5. Universiti Teknologi Petronas

    Ipoh, Malaysia

    1 h-index

    3 publications

    93 citations

  6. University of Milano-Bicocca

    Milan, Italy

    1 h-index

    1 publications

    51 citations

  7. Services Australia

    Canberra, Australia

    1 h-index

    5 publications

    75 citations

  8. Politecnico di Milano

    Milan, Italy

    1 h-index

    3 publications

    153 citations

1–8 of 21

Venues

  1. Journal Of Big Data

    1 publications · 169 citations

    1

    h-index

  2. Computer Fraud & Security

    1 publications · 23 citations

    1

    h-index

  3. SN Computer Science

    1 publications · 30 citations

    1

    h-index

  4. Chemical engineering transactions

    CET · 1 publications · 18 citations

    1

    h-index

  5. International Journal of Intelligent Systems

    1 publications · 13 citations

    1

    h-index

1–5