METHOD FOR DETECTING MEDICARE FRAUD, AND SYSTEM AND STORAGE MEDIUM

WIPO Patent Application WO/2022/057057

A1

The present invention provides a method for detecting medicare fraud, and a system and a storage medium. The method comprises: acquiring a medical record of a patient, extracting a corresponding patient feature according to the acquired medical record, and according to the extracted patient feature and the correlation between the patient and a doctor, establishing a doctor-patient relationship neural network; inputting a pre-marked fraud sample into the established doctor-patient relationship neural network, training a fraud prediction model, and outputting, from the trained fraud prediction model, a predicted value of each patient node having a fraud behavior; and according to the output predicted value, determining whether the patient corresponding to the node has a fraud behavior. By means of a machine learning method, whether a patient has a fraud behavior is predicted, so that the difficulty of predicting a fraud behavior is reduced, a medicare fraud behavior can be effectively detected, and the health popularization of a medicare system is facilitated.

LI JIANQIANG (CN)
CHEN JIE (CN)
HU XIAONAN (CN)
LUO RUOHENG (CN)

PCT/CN2020/127183

March 24, 2022

November 06, 2020

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UNIV SHENZHEN (CN)

G06Q40/08

CN109636061A	2019-04-16
CN108334935A	2018-07-27
CN106446942A	2017-02-22
CN104598552A	2015-05-06
CN106446552A	2017-02-22
US20180293496A1	2018-10-11

JOHNSON INTELLECTUAL PROPERTY AGENCY (SHENZHEN) (CN)

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