Healthcare Insurance Frauds: Taxonomy and Blockchain-Based Detection Framework (Block-HI)

Abstract

Medical health insurance fraud has been a major concern for the healthcare industry and governmental institutions. In the United States, the health insurance companies recorded a loss of tens of billions yearly due to healthcare fraud. Some types of fraud are at the risk of the patient's health. This is because the system that performs the manual processing of medical insurance claims frequently misses the endorsement of some stakeholders (such as the patient, pharmaceutical companies, wholesale dealers, and medical equipment suppliers) in a claim's validation process. Blockchain is a peer-to-peer distributed system that can enable the validation of healthcare claims in a secure, immutable, and transparent manner. We present a taxonomy of healthcare insurance claims frauds, and we propose and evaluate a blockchain-based healthcare insurance claims fraud detection framework.