We propose a simple, but effective, tool to detect possible anomalies in the services prescribed by a health care provider (HP) compared to his/her colleagues in the same field and environment. Our method is based on the concentration function which is an extension of the Lorenz curve widely used in describing uneven distribution of wealth in a population. The proposed tool provides a graphical illustration of a possible anomalous behavior of the HPs and it can be used as a pre-screening device for further investigations of potential medical fraud.

On the Use of the Concentration Function in Medical Fraud Assessment.

IEVA, FRANCESCA;
2017-01-01

Abstract

We propose a simple, but effective, tool to detect possible anomalies in the services prescribed by a health care provider (HP) compared to his/her colleagues in the same field and environment. Our method is based on the concentration function which is an extension of the Lorenz curve widely used in describing uneven distribution of wealth in a population. The proposed tool provides a graphical illustration of a possible anomalous behavior of the HPs and it can be used as a pre-screening device for further investigations of potential medical fraud.
Fraud detection, Lorentz Curve, Health care providers Unsupervised data mining
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11311/1044624
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