Publication Results

Code: 28/2013
Title: Statistical Issues in Medical Fraud Assessment
Date: Monday 24th June 2013
Author(s) : Ekin, T.; Ieva, F.; Ruggeri, F.; Soyer, R.
Download link:
Abstract: In this paper we provide a survey of the statistical issues in medical fraud assessment. We discuss different types of medical fraud and the type of fraud data that arise in different situations and give a review of the statistical methods that use such data to assess fraud. We also discuss conspiracy fraud and the associated dyadic data and introduce Co-clustering methods which have not been previously considered in the medical fraud literature. In so doing, we present some recent work on Bayesian co-clustering for fraud assessment and its extensions. Furthermore, we discuss potential use of decision theoretic methods in fraud detection and demonstrate an example for evaluating fraud detection tools.