Blockchain and AI-Empowered Healthcare Insurance Fraud Detection: an Analysis, Architecture, and Future Prospects
Nowadays, health insurance has become an essential part of people’s lives as the number of health issues increases. Healthcare emergencies can be troublesome for people who can’t afford huge expenses. Health insurance helps people cover healthcare services expenses in case of a...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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IEEE
2022-01-01
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| Series: | IEEE Access |
| Subjects: | |
| Online Access: | https://ieeexplore.ieee.org/document/9843995/ |
| _version_ | 1811220991134662656 |
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| author | Khyati Kapadiya Usha Patel Rajesh Gupta Mohammad Dahman Alshehri Sudeep Tanwar Gulshan Sharma Pitshou N. Bokoro |
| author_facet | Khyati Kapadiya Usha Patel Rajesh Gupta Mohammad Dahman Alshehri Sudeep Tanwar Gulshan Sharma Pitshou N. Bokoro |
| author_sort | Khyati Kapadiya |
| collection | DOAJ |
| description | Nowadays, health insurance has become an essential part of people’s lives as the number of health issues increases. Healthcare emergencies can be troublesome for people who can’t afford huge expenses. Health insurance helps people cover healthcare services expenses in case of a medical emergency and provides financial backup against indebtedness risk. Health insurance and its several benefits can face many security, privacy, and fraud issues. For the past few years, fraud has been a sensitive issue in the health insurance domain as it incurs high losses for individuals, private firms, and governments. So, it is essential for national authorities and private firms to develop systems to detect fraudulent cases and payments. A high volume of health insurance data in electronic form is generated, which is highly sensitive and attracts malicious users. Motivated by these facts, we present a systematic survey for Artificial Intelligence (AI) and blockchain-enabled secure health insurance fraud detection in this paper. This paper presents a taxonomy of various security issues in health insurance. We proposed a blockchain and AI-based secure and intelligent system to detect health insurance fraud. Then, a case study related to health insurance fraud is presented. Finally, the open issues and research challenges in implementing the blockchain and an AI-empowered health insurance fraud detection system is presented. |
| first_indexed | 2024-04-12T07:52:22Z |
| format | Article |
| id | doaj.art-750d3ee9b6e14c4890128762409734b4 |
| institution | Directory Open Access Journal |
| issn | 2169-3536 |
| language | English |
| last_indexed | 2024-04-12T07:52:22Z |
| publishDate | 2022-01-01 |
| publisher | IEEE |
| record_format | Article |
| series | IEEE Access |
| spelling | doaj.art-750d3ee9b6e14c4890128762409734b42022-12-22T03:41:34ZengIEEEIEEE Access2169-35362022-01-0110796067962710.1109/ACCESS.2022.31945699843995Blockchain and AI-Empowered Healthcare Insurance Fraud Detection: an Analysis, Architecture, and Future ProspectsKhyati Kapadiya0Usha Patel1https://orcid.org/0000-0003-1392-5160Rajesh Gupta2https://orcid.org/0000-0003-3298-4238Mohammad Dahman Alshehri3https://orcid.org/0000-0001-9520-330XSudeep Tanwar4https://orcid.org/0000-0002-1776-4651Gulshan Sharma5Pitshou N. Bokoro6https://orcid.org/0000-0002-9178-2700Department of Computer Science and Engineering, Institute of Technology, Nirma University, Ahmedabad, Gujarat, IndiaDepartment of Computer Science and Engineering, Institute of Technology, Nirma University, Ahmedabad, Gujarat, IndiaDepartment of Computer Science and Engineering, Institute of Technology, Nirma University, Ahmedabad, Gujarat, IndiaDepartment of Computer Science, College of Computers and Information Technology, Taif University, Taif, Saudi ArabiaDepartment of Computer Science and Engineering, Institute of Technology, Nirma University, Ahmedabad, Gujarat, IndiaDepartment of Electrical Engineering Technology, University of Johannesburg, Johannesburg, South AfricaDepartment of Electrical Engineering Technology, University of Johannesburg, Johannesburg, South AfricaNowadays, health insurance has become an essential part of people’s lives as the number of health issues increases. Healthcare emergencies can be troublesome for people who can’t afford huge expenses. Health insurance helps people cover healthcare services expenses in case of a medical emergency and provides financial backup against indebtedness risk. Health insurance and its several benefits can face many security, privacy, and fraud issues. For the past few years, fraud has been a sensitive issue in the health insurance domain as it incurs high losses for individuals, private firms, and governments. So, it is essential for national authorities and private firms to develop systems to detect fraudulent cases and payments. A high volume of health insurance data in electronic form is generated, which is highly sensitive and attracts malicious users. Motivated by these facts, we present a systematic survey for Artificial Intelligence (AI) and blockchain-enabled secure health insurance fraud detection in this paper. This paper presents a taxonomy of various security issues in health insurance. We proposed a blockchain and AI-based secure and intelligent system to detect health insurance fraud. Then, a case study related to health insurance fraud is presented. Finally, the open issues and research challenges in implementing the blockchain and an AI-empowered health insurance fraud detection system is presented.https://ieeexplore.ieee.org/document/9843995/Healthcare insurancefraud detectionAIblockchainsecurity |
| spellingShingle | Khyati Kapadiya Usha Patel Rajesh Gupta Mohammad Dahman Alshehri Sudeep Tanwar Gulshan Sharma Pitshou N. Bokoro Blockchain and AI-Empowered Healthcare Insurance Fraud Detection: an Analysis, Architecture, and Future Prospects IEEE Access Healthcare insurance fraud detection AI blockchain security |
| title | Blockchain and AI-Empowered Healthcare Insurance Fraud Detection: an Analysis, Architecture, and Future Prospects |
| title_full | Blockchain and AI-Empowered Healthcare Insurance Fraud Detection: an Analysis, Architecture, and Future Prospects |
| title_fullStr | Blockchain and AI-Empowered Healthcare Insurance Fraud Detection: an Analysis, Architecture, and Future Prospects |
| title_full_unstemmed | Blockchain and AI-Empowered Healthcare Insurance Fraud Detection: an Analysis, Architecture, and Future Prospects |
| title_short | Blockchain and AI-Empowered Healthcare Insurance Fraud Detection: an Analysis, Architecture, and Future Prospects |
| title_sort | blockchain and ai empowered healthcare insurance fraud detection an analysis architecture and future prospects |
| topic | Healthcare insurance fraud detection AI blockchain security |
| url | https://ieeexplore.ieee.org/document/9843995/ |
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