Medical fraud behavior detection method and system based on multi-view bi-clustering

Abstract

The invention provides a medical treatment fraud behavior detection method and system based on multi-view biclustering. The method comprises the steps: obtaining treatment information and demographicinformation, and carrying out the preprocessing of the obtained data; according to the medical insurance medical records of the medical insurance insured individuals obtained after preprocessing, performing double clustering on a first view formed by the insured person set, the medical seeking time and the medical seeking place information set and a second view formed by the insured person set andthe medicine information set at the same time to obtain a patient cluster with consistent cross views as a medical seeking fraud behavior group; according to the method, a biclustering algorithm is utilized, Meanwhile, a health medical knowledge base is introduced, so that suspicious patient groups frequently seeing a doctor at the same time and the same place can be mined, and misjudged normal patients caused by long-term regular doctor seeing can be filtered, and therefore, medical insurance fraudulent behaviors can be identified more accurately.

Description

technical field [0001] The present disclosure relates to the field of computer technology, in particular to a method and system for detecting medical fraud based on multi-view bi-clustering. Background technique [0002] The statements in this section merely provide background information related to the present disclosure and may not necessarily constitute prior art. [0003] The medical insurance system is a social insurance system established to compensate workers for economic losses caused by disease risks. [0004] With the vigorous development of the medical insurance business, a small number of criminals began to defraud the medical insurance fund out of interests. [0005] The inventors of the present disclosure found that the traditional medical insurance anti-fraud work mainly relies on formulating rules. First, the medical insurance fraud rules are formulated, based on the rules to identify the medical treatment behavior of the insured person, and determine the fr...

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Problems solved by technology

[0007] In view of the above-mentioned behaviors, the previous identification methods of abnormal co-occurrence medical treatment fraud only consider mining suspicious patient groups who frequently seek medical treatment at the same time and place, but do not consider the situation that some normal patients are misjudged due to long-term regular medical treatment. The test results are not accurate enough

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