Medical insurance group fraud abnormal behavior detection method and device and electronic equipment

Abstract

The invention discloses a medical insurance group fraud abnormal behavior detection method and device, and electronic equipment. The method comprises the steps of classifying patient information according to hospitals and disease types of patients; analyzing at least two pieces of patient information of the target disease category of the target hospital, wherein the target patient group comprisesat least two target patients, the hospital admission time difference between the at least two target patients is smaller than or equal to a first target time threshold value, and the hospital discharge time difference between the at least two target patients is smaller than or equal to a second target time threshold value; and counting target patient groups of a plurality of disease categories inthe plurality of hospitals, determining at least two abnormal patients as abnormal patient groups, the at least two abnormal patients appearing in the N target patient groups at the same time, and N >= 3. According to the method provided by the embodiment of the invention, the abnormal patient group with regular treatment behaviors can be determined, the fraudulent abnormal behaviors of the medical insurance group are further determined, and the accuracy of positioning the medical insurance fraudulent patients is improved.

Description

technical field [0001] The invention relates to the technical field of medical insurance, in particular to a method, device and electronic equipment for detecting abnormal fraudulent behavior of medical insurance groups. Background technique [0002] The supervision of medical insurance funds is a long-term and arduous task, and it is a key measure to protect the interests of the majority of insured people in my country. It has always occupied an important position in the construction of the medical insurance supervision system. Especially on September 11, 2018, the National Medical Insurance Administration, the National Health and Health Commission, the Ministry of Public Security, and the State Food and Drug Administration jointly issued the "Notice on Launching a Special Action to Combat Fraud to Obtain Medical Security Funds", proposing a nationwide crackdown on After the special operation of defrauding medical security funds by fraud, this work has become a hot and sens...

AI Technical Summary

Problems solved by technology

[0005] The embodiment of the present invention provides a method, device and electronic device for detecting abnormal behavior of medical insurance group fraud, so as to solve the problem that the existing technology supervises patients suffering from various diseases, but the accuracy of locating patients with medical insurance fraud is low question

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