Researchers Use Machine Learning to Detect Medicare Fraud

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Using a highly sophisticated form of pattern matching, researchers from Florida Atlantic University's College of Engineering and Computer Science are teaching "machines" to detect Medicare fraud. About $19 billion to $65 billion is lost every year because of Medicare fraud, waste, or abuse. Like the proverbial "needle in a haystack," human auditors or investigators have the painstaking task of manually checking thousands of Medicare claims for specific patterns that could indicate foul play or fraudulent behaviors. Furthermore, according to the U.S. Department of Justice, right now fraud enforcement efforts rely heavily on health care professionals coming forward with information about Medicare fraud. "The Effects of Varying Class Distribution on Learner Behavior for Medicare Fraud Detection With Imbalanced Big Data," published in the journal Health Information Science and Systems, uses big data from Medicare Part B and employs advanced data analytics and machine learning to automate the fraud detection process.