crossrefFuture Internet2025-12-18Cited by 3
Methodology for Detecting Suspicious Claims in Health Insurance Using Supervised Machine Learning
Jose Villegas-Ortega, Luis Napoleon Quiroz Aviles, Juan Nazario Arancibia, Wilder Carpio Montenegro, Rosa Delgadillo, David Mauricio
Health insurance fraud (HIF) places a substantial economic burden on global health systems. While supervised machine learning (SML) offers a promising solution for its detection, most approaches are ad hoc and lack a systematic methodological framework that ensures replicability,…