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Gang insurance fraud behavior identification method and system based on frequent set mining

An identification method and frequent set technology, applied in structured data retrieval, instrumentation, electrical digital data processing, etc., can solve problems such as the internal structure of the system and the complexity of scheduling algorithms, and achieve the effect of improving review efficiency and simplifying the review process

Pending Publication Date: 2020-04-17
PACIFIC MEDICAL HEALTH MANAGEMENT CO LTD
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Problems solved by technology

The internal structure and scheduling algorithm of the above-mentioned system are complex and not applicable to this case

Method used

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  • Gang insurance fraud behavior identification method and system based on frequent set mining

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Embodiment Construction

[0018] The present invention will be further described below in conjunction with the accompanying drawings and specific embodiments, but not as a limitation of the present invention.

[0019] The present invention is based on FP-growth (Frequent Pattern Growth) analysis and modeling, and sets different minimum support degrees for different medical categories. After processing the data, the FP-growth algorithm is used to mine frequent data sets, which are used as gang fraud cases. investigation. Specifically, see figure 1 As shown, the present invention is based on the gang fraud insurance behavior identification method of frequent set mining, comprising the following steps:

[0020] S1. Classify the medical billing data according to the medical category. Since the calculation speed of the frequent item mining method is slow, the data is grouped according to the business significance before mining, which can greatly improve the operating efficiency. Firstly, the medical billi...

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Abstract

The invention discloses a gang insurance fraud behavior identification method and system based on frequent set mining. The method comprises the following steps: S1, classifying treatment settlement data according to medical categories, establishing a database by adopting personnel numbers, treatment dates, treatment institution names, minimum support degrees and the like based on the medical categories, reserving the personnel numbers, the treatment dates and the treatment institution names, and forming a list by adopting the personnel numbers treated in the same medical institution on the same date; s2, setting a minimum support degree; S3, creating an FP-tree; s4, creating a condition FP-Tree, and performing frequent item search to obtain a whole frequent item set; and S5, carrying out data screening to obtain original treatment behavior data of the suspected gang fraudulent cases. According to the historical medical behavior data, to-be-examined data is reduced in a large range in combination with the business logic, the examination process of gang medical insurance fraud cases is greatly simplified, and the examination efficiency is improved.

Description

technical field [0001] The invention belongs to the technical field of data mining, and in particular relates to a method and system for identifying group insurance fraud behaviors based on frequent set mining. Background technique [0002] Basic medical insurance and critical illness medical insurance are important components of my country's social insurance. They cover a wide range of people and benefit a wide range of people. They take care of the basic living needs of the masses, which is of great significance. The amount of state financial subsidies for them is also increasing. Since medical insurance funds play an important role in protecting people's livelihood, fraudulent misappropriation of medical insurance funds will affect the normal operation of the fund, which is contrary to the original intention of the basic medical insurance system to protect people's lives and prevent poverty due to illness. The social impact caused by the behavior is very bad, especially t...

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Application Information

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Patent Type & Authority Applications(China)
IPC IPC(8): G06Q40/08G06F16/22G06F16/2457
CPCG06Q40/08G06F16/2246G06F16/2457
Inventor 闫续冉
Owner PACIFIC MEDICAL HEALTH MANAGEMENT CO LTD
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