Medical insurance violation object discovery method and device
A technology for discovering methods and objects, applied in the computer field, can solve problems such as difficulty in accurately discovering medical insurance violation objects, and achieve the effects of accurate discovery, low investment cost, and simple process
Pending Publication Date: 2021-08-10
PEKING UNIV +1
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Problems solved by technology
[0004] The invention provides a method and device for discovering medical insurance violation objects, which are used to solve the defect that it is difficult to accurately find medical insurance violation objects in the prior art, and realize more accurate discovery of medical insurance violation objects
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[0043] In order to make the purpose, technical solutions and advantages of the present invention clearer, the technical solutions in the present invention will be clearly and completely described below in conjunction with the accompanying drawings in the present invention. Obviously, the described embodiments are part of the embodiments of the present invention , but not all examples. Based on the embodiments of the present invention, all other embodiments obtained by persons of ordinary skill in the art without creative efforts fall within the protection scope of the present invention.
[0044] In the description of the present invention, it should be noted that unless otherwise specified and limited, the terms "installation", "connection" and "connection" should be understood in a broad sense, for example, it can be a fixed connection or a detachable connection. Connected, or integrally connected; it may be mechanically connected or electrically connected; it may be directly...
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The invention provides a medical insurance violation object discovering method and device, and the method comprises the steps: constructing a plurality of relation graphs based on the transaction data of a medical insurance insured in a target region in a first target time period, and taking at least one relation graph as a target relation graph; based on a community discovery algorithm, performing community discovery on the target relation graph, and determining a medical insurance violation object, wherein nodes in the relational graph represent the medical insurance insured, and edges in the relational graph represent the relationship between transactions of the medical insurance insured, which are represented by two nodes connected with the edges, of purchasing medicines. According to the medical insurance violation object discovery method and device provided by the invention, after the target relation graph is acquired, community discovery is performed on the target relation graph, and the medical insurance violation object is determined, so that the medical insurance violation object can be more accurately discovered, the process of discovering the medical insurance violation object is simple, and the investment cost is lower.
Description
technical field [0001] The invention relates to the field of computer technology, in particular to a method and device for discovering medical insurance violation objects. Background technique [0002] Using other people's medical insurance cards to obtain medical insurance drugs for profit, instructing insured personnel to prescribe medicines and then recycle and sell them for profit, and medical institutions to obtain medical insurance funds will lead to a large amount of additional expenses for the medical insurance system and seriously affect the safety of medical insurance funds. [0003] In the existing technology, medical insurance violations can be found based on data mining and machine learning technologies. For example, by modeling and counting the full outpatient data of a city’s medical insurance bureau in a single month, if a doctor’s frequency curve and average frequency of seeing a doctor are found If the curves are inconsistent, and there is an abnormal situa...
Claims
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Patent Timeline
Login to View More IPC IPC(8): G06F16/901G06Q40/08G06Q50/00
CPCG06F16/9024G06Q50/01G06Q40/08
Inventor 刘学洋刘英杰张文默舒正胡文蕙
Owner PEKING UNIV