Table 8 Identification of fraudulent rules through applied techniques
From: Healthcare insurance fraud detection using data mining
SNo | Rules | IF | CBLOF | OCSVM | ECOD |
|---|---|---|---|---|---|
1 | Diagnosis Code=7802 \(\wedge\) Patient Pay Less Than 5000 USD | 0 | 0 | 1 | 1 |
2 | Procedure Code =3995 \(\wedge\) Parient Pay More Than 5000 USD and Less Than 10000 USD | 0 | 0 | 0 | 1 |
3 | Procedure Code=8154 \(\wedge\) Patient Pay More Than 10000 USD and Less Than 15000 USD | 1 | 1 | 0 | 1 |
4 | Procedure Code=8154 \(\wedge\) Patient Stay is 3 Days | 0 | 1 | 1 | 1 |
5 | Patient Stay= 1 Day[s] \(\wedge\) Parient Pay More Than 5000 USD and Less Than 10000 USD | 1 | 0 | 0 | 0 |
6 | Patient Stay =6 Day[s] \(\wedge\) Patient Pay More Than 10000 USD and Less Than 15000 USD | 1 | 0 | 0 | 0 |
7 | Patient Stay=5 Day[s] \(\wedge\) Patient Pay More Than 10000 USD and Less Than 15000 USD | 1 | 0 | 0 | 0 |
8 | Patient Stay=4 Day[s] \(\wedge\) Patient Pay More Than 10000 USD and Less Than 15000 USD | 1 | 1 | 0 | 0 |
9 | Patient Pay More Than 10000 and Less Than 15000 USD \(\wedge\) Patient Stay is 4 Days | 1 | 1 | 0 | 0 |
10 | Patient Stay=1 Day[s] \(\wedge\) Patient Pay More Than 10000 USD and Less Than 15000 USD | 1 | 0 | 0 | 0 |
11 | Patient Pay More Than 5000 and Less Than 10000 USD \(\wedge\) Patient Stay is 1 Days | 1 | 0 | 0 | 0 |
12 | Patient Pay More Than 10000 and Less Than 15000 USD \(\wedge\) Patient Stay is 2 Days | 1 | 1 | 0 | 0 |
13 | Patient Stay=2 Day[s] \(\wedge\) Patient Pay More Than 10000 USD and Less Than 15000 USD | 1 | 1 | 0 | 0 |
14 | Patient Pay More Than 10000 and Less Than 15000 USD \(\wedge\) Procedure Code is 8154 | 1 | 1 | 0 | 1 |
15 | Patient Pay More Than 10000 and Less Than 15000 USD \(\wedge\) Patient Stay is 5 Days | 1 | 0 | 0 | 0 |
16 | Patient Pay More Than 10000 and Less Than 15000 USD \(\wedge\) Patient Stay is 1 Days | 1 | 0 | 0 | 0 |
17 | Patient Pay More Than 10000 and Less Than 15000 USD \(\wedge\) Patient Stay is 6 Days | 1 | 0 | 0 | 0 |
18 | Patient Stay=3 Day[s] \(\wedge\) Procedure Code is 8154 | 0 | 1 | 1 | 1 |
19 | Patient Less Than 5000 USD \(\wedge\) Diagnosis Code is 7802 | 0 | 0 | 1 | 1 |
20 | Patient Pay More Than 5000 and Less Than 10000 USD \(\wedge\) Procedure Code is 3995 | 0 | 0 | 0 | 1 |