Medical Insurance Fraud Detection Based on Block Chain and Deep Learning Approach
Bijaya Kumar Sethi, Debabrata Singh, Prakash Kumar Sarangi
Abstract
To control the medical expenses people are decided to do some insurance plans and the Health Insurance Department's duty of controlling medical expenses has become increasingly vital. Traditional medical insurance settlements are paid per-service, which results in a lot of unnecessary costs. Now a day, the single-disease payment mechanism has been frequently employed to address this issue. However, there is a possibility of fraud with single-disease payments. In this work, we have presented a methodology for detecting the health insurance fraud entrenched block chain and deep learning techniques, that can automatically recognize apprehensive medical records to assure sustainable execution of single-disease payment and reduce medical insurance worker's workload. We also proposed a medical record storage and management procedure based on consortium block chain to assure data security, immutability, traceability, and audit ability. The suggested system may effectively identify fraud and considerably increase the efficiency of medical insurance evaluations, as demonstrated by experiments on two real datasets from two hospitals.