Rédiger un PREreview

Fraud in the health landscape is an aggravating issue, with far-reaching consequences burdening the financial stability of the health industry and threatening the quality of medical care. It results from vulnerabilities within the current healthcare framework that are exploited by the fraudsters in their favor. In spite of many developed models that aim to detect fraudulent patterns in insurance claims, the accuracy of such models frequently suffers as a result of the imbalance issue of the Medicare dataset and irrelevant features. This study ventures to improve detection performance and accuracy by employing a deep learning model along with data sampling and feature selection techniques. Comparative analysis among different combinations is conducted to determine their efficacy to enhance the accuracy of the fraud detection model. Hence, the suggested model clearly demonstrates that a combination of myriad data sampling and feature selection techniques is helping to improve accuracy and performance. The accuracy was thus 95.4%, with negligible evidence of overfitting detected using both Chisquare and Synthetic Minority Over-sampling (SMOTE) techniques. Ultimately, the study findings underscore the significance of employing combined techniques instead of using only the baseline deep learning model for better performance in detecting Medicare insurance fraud.