Li Jing, Huang Kuei-Ying, Jin Jionghua, Shi Jianjun
Department of Industrial Engineering, Arizona State University, P.O. Box 875906, Tempe, AZ 85287-5906, USA.
Health Care Manag Sci. 2008 Sep;11(3):275-87. doi: 10.1007/s10729-007-9045-4.
Fraud and abuse have led to significant additional expense in the health care system of the United States. This paper aims to provide a comprehensive survey of the statistical methods applied to health care fraud detection, with focuses on classifying fraudulent behaviors, identifying the major sources and characteristics of the data based on which fraud detection has been conducted, discussing the key steps in data preprocessing, as well as summarizing, categorizing, and comparing statistical fraud detection methods. Based on this survey, some discussion is provided about what has been lacking or under-addressed in the existing research, with the purpose of pinpointing some future research directions.
欺诈和滥用行为给美国医疗保健系统带来了巨大的额外费用。本文旨在全面综述应用于医疗保健欺诈检测的统计方法，重点包括对欺诈行为进行分类、识别用于欺诈检测的数据的主要来源和特征、讨论数据预处理的关键步骤，以及总结、分类和比较统计欺诈检测方法。基于这项综述，对现有研究中存在的不足或未充分探讨的方面进行了一些讨论，目的是明确一些未来的研究方向。
