Medical Knowledge Graph to Enhance Fraud, Waste, and Abuse Detection on Claim Data: Model Development and Performance Evaluation.
Haixia SunJin XiaoWei ZhuYilong HeSheng ZhangXiaowei XuLi HouJiao LiYuan NiGuotong XiePublished in: JMIR medical informatics (2020)
The medical knowledge graph-based method successfully identified suspected cases of FWA (such as fraud diagnosis, excess prescription, and irrational prescription) from the claim documents, which helped to improve the efficiency of claim processing.