Procedure code overutilization detection from healthcare claims using unsupervised deep learning methods

Procedure code overutilization detection from healthcare claims using unsupervised deep learning methods

Abstract Background Fraud, Waste, and Abuse (FWA) in medical claims have a negative impact on the quality and cost of healthcare. A major component of FWA in claims is procedure code overutilization, where one or more prescribed procedures may not be relevant to a given diagnosis and patient profile...

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Bibliographic Details
Main Authors: Michael Suesserman, Samantha Gorny, Daniel Lasaga, John Helms, Dan Olson, Edward Bowen, Sanmitra Bhattacharya
Format: Article
Language:English
Published: BMC 2023-09-01
Series:BMC Medical Informatics and Decision Making
Subjects:
Fraud, waste, and abuse
Procedure code overutilization
Unsupervised learning
Deep autoencoder
Feature-weighted loss function
Online Access:https://doi.org/10.1186/s12911-023-02268-3

Internet

https://doi.org/10.1186/s12911-023-02268-3

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