On the Use of the Concentration Function in Medical Fraud Assessment

ABSTRACT

We propose a simple, but effective, tool to detect possible anomalies in the services prescribed by a health care provider (HP) compared to his/her colleagues in the same field and environment. Our method is based on the concentration function that is an extension of the Lorenz curve widely used in describing uneven distribution of wealth in a population. The proposed tool provides a graphical illustration of a possible anomalous behavior of the HPs and it can be used as a prescreening device for further investigations of potential medical fraud.

KEYWORDS:

• Fraud detection
• Health care providers
• Lorenz curve
• Unsupervised data mining