Project Description

Case Description

Our customer received medical claims for reimbursement. All claims are coming from insurance companies, clinics, and hospitals and pharmacies. Claims were increasing day by day and there was no system to measure a claim is a genuine or fraud. We aided the prevention and early detection of medical insurance fraud, fraudulent claims

Solution

We built machine-learning models for following techniques to detect fraud.

  • Gap Testing
  • Classification
  • Summing of numeric values
  • Validating entry dates
  • Calculation of statistical parameters

We found the areas in which fraud occurred, and what fraudulent activity looked like in the data.