Healthcare Insurance Fraud Detection Using Blockchain and AI: An Analysis, Architecture, and Future Prospects

PROJECT TITLE :

Blockchain and AI-empowered Healthcare Insurance Fraud Detection An Analysis, Architecture, and Future Prospects

ABSTRACT:

As the prevalence of health problems continues to rise, having health insurance has evolved into an increasingly vital component of people's lives. People who are financially strapped and face a medical emergency can find themselves in a difficult position. People who have health insurance are better able to cover the costs of healthcare services in the event of a medical emergency and have a financial safety.Net to protect them from the possibility of incurring debt. Problems with fraud, theft, and invasion of privacy can arise in connection with health insurance and its many benefits. In the field of health insurance, fraud has been a contentious issue for the past few years due to the significant financial losses it causes for individuals, private businesses, and government agencies. Therefore, the development of systems to detect fraudulent cases and payments is an absolute necessity for both public institutions and private businesses. It generates a large amount of data in electronic form pertaining to health insurance, which is extremely sensitive and attracts users with malicious intentions. In this paper, we present a systematic survey for Artificial Intelligence (AI) and Blockchain-enabled secure health insurance fraud detection. The motivation for this paper comes from the aforementioned facts. This article provides a taxonomy of the many different security concerns that are associated with health insurance. We proposed a secure and intelligent system to detect health insurance fraud that is based on Blockchain technology and artificial intelligence. After that, a case study relating to fraudulent activity involving health insurance is presented. The presentation concludes with a discussion of the unresolved questions and research hurdles that remain to be overcome in order to successfully implement a health insurance fraud detection system that is powered by AI.

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