Title :
Data driven implementation to filter fraudulent medicaid applications
Author :
Suleiman, Muhammad ; Agrawal, Rajeev ; Seay, Cameron ; Grosky, William
Author_Institution :
Sch. of Technol., NCA&T, Greensboro, NC, USA
Abstract :
There has been much work to improve current IT Healthcare system to manage and maintain health records. The U.S government is trying to integrate different type of healthcare data to provide a centralized system for healthcare service providers and patients. However, less attention is paid to implement a system to detect fraudulent application, specifically in Medicaid. In this paper, we propose a data driven implementation using a layered architecture to filter fraudulent applications for Medicaid. In this system, we utilize a set of public and private databases which contain asset records of an individual. These asset records are used to determine the Medicaid eligibility of an applicant.
Keywords :
data mining; health care; medical administrative data processing; security of data; IT healthcare system; US government; data driven implementation; fraudulent Medicaid application detection; fraudulent application detection; health record maintenance; healthcare service providers; patients; private databases; public databases; Computer architecture; Data mining; Databases; Government; Medical services; Vehicles; Data Driven; Data Mining; Fraud Detection; Healthcare; Heterogenous Database; Mediciad; Scoring Model;
Conference_Titel :
SOUTHEASTCON 2014, IEEE
Conference_Location :
Lexington, KY
DOI :
10.1109/SECON.2014.6950652