Healthcare Insurance Fraud Detection Using AI and Blockchain

Authors: Dr M.A. Chaudhari, Rushikesh Patil, Monali Patkal, Sanika Pagare, Soniya Kolge

Country: India

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Abstract: In today's society, health insurance is indispensable for managing medical emergencies, yet the persistent threat of fraud within the industry necessitates robust detection mechanisms. This paper proposes a systematic approach to secure health insurance fraud detection, utilizing blockchain technology and artificial intelligence (AI). By categorizing security concerns such as privacy breaches and fraudulent claims, emphasizes the urgency for effective fraud detection methods. The suggested solution advocates for leveraging blockchain's data integrity and AI's analytical capabilities to identify fraudulent activities accurately. Through a practical case study, the efficacy of this approach in detecting health insurance fraud is demonstrated, underscoring its real-world applicability. Moreover, the paper discusses unresolved challenges and future research directions, including scalability and regulatory compliance, to further enhance fraud detection in health insurance systems. The ultimate goal of this all-encompassing framework is to improve the honesty and reliability of health insurance operations, which will benefit all parties involved—including corporations, governments, and individual policyholders.

Keywords: healthcare insurance, SVM, J48, blockchain, proof of work, SHA-256

Paper Id: 230595

Published On: 2024-04-23

Published In: Volume 12, Issue 2, March-April 2024

Cite This: Healthcare Insurance Fraud Detection Using AI and Blockchain - Dr M.A. Chaudhari, Rushikesh Patil, Monali Patkal, Sanika Pagare, Soniya Kolge - IJIRMPS Volume 12, Issue 2, March-April 2024.

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