FRAUD LEAD DETECTION SYSTEM FOR EFFICIENTLY PROCESSING DATABASE-STORED DATA AND AUTOMATICALLY GENERATING NATURAL LANGUAGE EXPLANATORY INFORMATION OF SYSTEM RESULTS FOR DISPLAY IN INTERACTIVE USER INTERFACES

Systems and methods are described for automatically processing data stored in one or more databases using machine learning to detect entities (such as health care providers, health care plan members, patients, pharmacies, and so forth) associated with health care claims that are suspected of fraudul...

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Bibliographische Detailangaben
Hauptverfasser:	Wu, Diane, Agarwal, Rahul
Format:	Patent
Sprache:	eng
Schlagworte:	CALCULATING COMPUTER SYSTEMS BASED ON SPECIFIC COMPUTATIONAL MODELS COMPUTING COUNTING DATA PROCESSING SYSTEMS OR METHODS, SPECIALLY ADAPTED FORADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL, SUPERVISORYOR FORECASTING PURPOSES HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATIONTECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING ORPROCESSING OF MEDICAL OR HEALTHCARE DATA INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTEDFOR SPECIFIC APPLICATION FIELDS PHYSICS SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE,COMMERCIAL, FINANCIAL, MANAGERIAL, SUPERVISORY OR FORECASTINGPURPOSES, NOT OTHERWISE PROVIDED FOR
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Beschreibung
Zusammenfassung:	Systems and methods are described for automatically processing data stored in one or more databases using machine learning to detect entities (such as health care providers, health care plan members, patients, pharmacies, and so forth) associated with health care claims that are suspected of fraudulent, wasteful, and/or abusive activity. The techniques may further or alternatively involve generating and presenting, for a set of suspected entities, natural language explanatory information explaining how and/or why each of the respective suspected entities is considered to be suspected of fraudulent, wasteful, and/or abusive activity. Feedback provided by fraud analysts and/or other subject matter experts in the misuse detection space is used to facilitate misuse detection and misuse detection presentation.