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Health Insurance Fraud Detection: the Role of Advanced It Systems in Preventing and Identifying Fraud

Year: 2025

Type: article

Abstract: In this study, the usage of advanced IT systems such as AI, machine learning, blockchain and others is studied in the field of detection of health insurance fraud.Results indicate that AI driven fraud detection model improves fraud detection accuracy by a large margin, but decreases their false positives and financial losses.This integration of blockchain has encryption guaranteeing the safety of the data and that of claims processing.The findings imply that AI and blockchain complemented one another to make better fraud prevention in the health insurance sector.

Source: INTERNATIONAL JOURNAL OF COMPUTER ENGINEERING & TECHNOLOGY

DOI: 10.34218/ijcet_16_01_259

Author: Sunil Kumar Mudusu

Language: English

Topic: Blockchain Technology Applications and Security

Subfield: Information Systems

Field: Computer Science

Domain: Physical Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4407770919

FWCI: 1.107

Cites:

Cited by: 1

Related to: 10