Medical insurance reimbursement fraud detection method based on OCR

Abstract

The invention belongs to the technical field of medical security and image recognition, and discloses a medical insurance reimbursement fraud detection method based on OCR, and the method comprises the following steps: S1, obtaining a scanning image of a medical insurance reimbursement expense summary list, and carrying out the OCR recognition of the scanning image, and obtaining settlement expense detail data; s2, acquiring doctor-side medication detail data, judging whether the hospital ID of the doctor-side medication detail data is consistent with the hospital ID of the settlement expensedetail data or not, if so, entering a step S3, and otherwise, entering a step S4; s3, performing fuzzy comparison according to the settlement expense detail data and the doctor-side medication detaildata, judging whether the fields are consistent or not, if so, sending a detection qualification signal, and ending the method, otherwise, directly entering the step S4; and S4, sending out a detection disqualification signal, and carrying out manual key auditing. According to the invention, the problem that manual checking is time-consuming and labor-consuming in the prior art is solved, and medical insurance fund loss caused by medical insurance fraud is avoided.

Description

technical field [0001] The invention belongs to the technical field of medical security and image recognition, and in particular relates to an OCR-based method for detecting medical insurance reimbursement fraud. Background technique [0002] The medical insurance fund is mainly used to pay the inpatient and outpatient medical expenses of the insured residents. The scope and standard of payment are in accordance with the basic medical insurance insurance drug catalog, diagnosis and treatment items, and the scope and standards of medical service facilities. played an important role. [0003] With the continuous deepening of the reform of the social medical insurance system, the social security function of medical insurance has begun to appear. However, in recent years, some lawbreakers have been motivated by profit, and the cases of defrauding medical insurance funds by using the loopholes in the management of medical insurance pooling funds have intensified, which has had a...

AI Technical Summary

Problems solved by technology

[0006] For this reason, the purpose of the present invention is to provide an OCR-based medical insurance reimbursement fraud detection method, which solves the time-consuming and labor-consuming problem of manual verification in the prior art, and avoids the loss of medical insurance funds caused by medical insurance fraud.

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