Safeguarding medicare fund security is a key concern in the medical and healthcare fields. Effectively detecting the fraud groups from massive amounts of medicare claims data is technically challenging. Therefore, we developed an interactive fraud groups detection system named IFGDS. It can screen out suspicious claims data from a large volume of medicare claims data and then detect fraud groups with “ganging up” medical visit behaviors. IFGDS provides abundant visual monitoring and analysis tools as well as a user-friendly interaction experience. It facilitates users to view patients-related information. Moreover, IFGDS has high cross-platform-portability to handle a comprehensive range of data resources. In practice, IFGDS has been applied to medicare regulatory scenarios, and has successfully recovered medicare fund among several cities.
To make it more visual, we have posted a brief demo video on YouTube for access. URL: https://youtu.be/EH7G9phQMCo
In sample.csv, we provide some sample data for medicare claims data.
For more information, please see the article "IFGDS: An Interactive Fraud Groups Detection System for Medicare Claims Data".