Researchers teach 'machines' to detect Medicare fraud

IMAGE: This is Taghi M. Khoshgoftaar, Ph.D., co-author and Motorola Professor in FAU's Department of Computer and Electrical Engineering and Computer Science. 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.