HEALTH INSURANCE FRAUD DETECTION: THE ROLE OF ADVANCED IT SYSTEMS IN PREVENTING AND IDENTIFYING FRAUD

Abstract

In this study, the usage of advanced IT systems such as AI, machine learning, blockchain and others is studied in the field of detection of health insurance fraud. Results indicate that AI driven fraud detection model improves fraud detection accuracy by a large margin, but decreases their false positives and financial losses. This integration of blockchain has encryption guaranteeing the safety of the data and that of claims processing. The findings imply that AI and blockchain complemented one another to make better fraud prevention in the health insurance sector.