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 26 October 2010

Health Insurance Claims - Transactions Data

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Posted by: Laxman Ganapati

Public Sector Information Holder:NHI

Information Asset: Health Insurance Claims - Transactions Data

The Problem

I want to research abuse and fraud in Health Care claims, which burden the Health Care system.

I need two sample data sets - one for training and one for validation. The identity of the patients, providers, physicians, medication, devices and suppliers can be masked and mapped to original data by NHI after submission of results of research.

My ideal solution

To check irregularities in claims; to peg fraud and abuse of claims at 2% of public expenditure on health care.

What would I do

I want to use data mining and analytics to discover patterns, associations, sequence detection, etc., to build suitable models for segmentation of patients/providers, CART, Neural Networks tool, etc., that can aid informed decisions and policy-making.

Posted at Tuesday, 26 October 2010 11:50:40 (GMT Standard Time, UTC+00:00)  Comments [0] #