A risk detection method and apparatus based on data processing

Abstract

The embodiment of the invention discloses a risk detection method and a device based on data processing, wherein the risk detection method based on data processing comprises the following steps: obtaining a plurality of hospitalization settlement sheets which need to be reimbursed in a medical institution according to a unique identification code of the medical institution; obtaining a plurality of hospitalization settlement sheets which need to be reimbursed in the medical institution according to the unique identification code of the medical institution. Detecting similarity of multiple hospitalization settlement forms, and obtaining risk value of hospitalization settlement forms according to similarity of multiple hospitalization settlement forms; When it is determined that the risk value of the hospitalization settlement document is greater than the preset risk threshold, the hospitalization settlement document is set as the risk settlement document, and the reimbursement of the risk settlement document is not passed. By adopting the invention, the risk value of the hospitalization calculation sheet can be determined through the similarity calculation of a plurality of hospitalization settlement sheets, the efficiency and the accuracy of finding the illegal hospitalization settlement sheets can be improved, the passing rate of the illegal hospitalization settlement sheets can be reduced, and the standardization of the medical insurance reimbursement process can be played an active role.

Description

technical field [0001] The invention relates to the field of data processing, in particular to a method and device for risk detection based on data processing. Background technique [0002] Medical insurance refers to social medical insurance. Social medical insurance is a social insurance system established by the state and society in accordance with certain laws and regulations to provide workers within the scope of protection with basic medical needs in the event of illness. In the existing reimbursement process for hospitalization expenses, reimbursement can be made after the patient's illness has been reviewed. However, after the patient's disease has been reviewed, there may be cases where hospitals or individuals falsely issue hospitalization bills, swipe empty cards to defraud medical insurance funds, hang up beds for hospital reimbursement, or tamper with non-reimbursable drugs for reimbursement. Such violations indirectly It has caused social injustice and should...

AI Technical Summary

Problems solved by technology

However, after the patient's disease has passed the review, there may be cases where hospitals or individuals issue false hospitalization settlement statements, swipe cards to defraud medical insurance funds, stay in bed for hospital reimbursement, or tamper with non-reimbursable medicines for reimbursement medicines for reimbursement. Such violations are indirect caused social injustice and should be eradicated

[0003] In the existing verification process of inpatient medical insurance reimbursement, the Medical Insurance Administration can only review a single hospitalization settlement statement, and the audit efficiency and accuracy are very low, which is not conducive to the inspection of medical insurance reimbursement

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