• DocumentCode
    147499
  • 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
  • fYear
    2014
  • fDate
    13-16 March 2014
  • Firstpage
    1
  • Lastpage
    8
  • 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;
  • fLanguage
    English
  • Publisher
    ieee
  • Conference_Titel
    SOUTHEASTCON 2014, IEEE
  • Conference_Location
    Lexington, KY
  • Type

    conf

  • DOI
    10.1109/SECON.2014.6950652
  • Filename
    6950652