Fraud Detection in Healthcare

Fraud detection in healthcare refers to the processes and methods used to identify and prevent dishonest practices that can lead to financial losses for insurers, providers, and patients. This can involve billing for services not rendered, exaggerating illnesses, or submitting false claims. By analyzing patterns and data, including billing discrepancies and patient records, healthcare organizations can spot suspicious activities. Effective fraud detection helps maintain the integrity of the healthcare system, ensuring that resources are used appropriately and that patients receive the quality care they deserve.