大数据技术在医保反欺诈中的应用

Application Of Big Data Technology In Fraud Perception In Medical Insurance Services

目的:回顾和总结大数据技术在医保反欺诈工作中的应用现况,以提出决策依据及建议。方法:检索知网等数据库中的相关文献及相关网站,系统查找和分析大数据技术在医保欺诈行为识别中的应用原理、方法及实例。结果:基于医保大数据,采用有监督学习法、无监督学习法及两者结合的各类算法,我国已建立了多个针对医疗服务供方和需方的预警模型,对医保欺诈行为进行了较为准确的检出与预测。但我国大数据技术起步较晚,有待进一步发展并应用于医保反欺诈工作。结论:大数据技术可有效预测和防控医保欺诈行为。我国需大力推动其在医保领域的应用,保障医保基金安全平稳运行。

Objectives:This paper reviews and summarizes the application status of big data technology in anti fraud work of medical insurance,so as to put forward decision-making basis and suggestions.Methods:Search relevant literature and websites in HowNet and other databases,systematically search and analyze the application principle,method and example of big data technology in medical insurance fraud identifi cation.Results:Based on the big data of medical insurance,using supervised learning method,unsupervised learning method and all kinds of algorithms combined with the two,China has established a number of early warning models for medical service providers and demanders to detect and predict medical insurance fraud more accurately.However,China's big data technology started late and needs further development and application in medical insurance anti fraud work.Conclusion:Big data technology can eff ectively predict and prevent medical insurance fraud.China needs to vigorously promote its application in the field of medical insurance to ensure the safety of medical insurance fund.