IDENTIFYING HEALTH INSURANCE CLAIM FRAUDS USING MACHINE LEARNING CONCEPT

Abstract

— Patients depend on health insurance provided by the governmentsystems, private systems, or both to utilizethe high-priced healthcare expenses. Thisdependency on health insurance draws some healthcare service providers to commit insurance frauds. In this paper, we perform a comparative analysis on various classification algorithms, namely Support Vector Machine (SVM), Decision-Tree (DT), K-Nearest Neighbor (KNN), Logistic Regression (LR), to detect the health insurance fraud. The effectiveness of the algorithms are observed on the basis of performance metrics: Precision, Recall and F1-Score