Using Big Data Analytics to Detect Fraud in Healthcare Provision

Big Data technologies can contribute to medical fraud detection. The aim of this paper is to present by an example, the methodological approach of the Hellenic National Organization for the Provision of Health Services (EOPYY) in data analysis to detect financial or medical fraud in claims. To analyze the data for fraud detection, a selection of prescription data from the year 2018 were examined. The Local Correlation Integral algorithm was applied to detect any outliers on the dataset. The results revealed that 7 out of 879 products could be characterized as outliers. These outliers must be further investigated to determine if they represent fraud cases. According to the results of this study, this outliers detection approach can support and help the fraud detection process conducted by the auditing services in Healthcare sector.