HealthCare Claims is an AI-based Android Application tool that enables people to flag the claims as fraud or not.
A healthcare or a medical insurance fraud is more commonly defined as knowingly executing treatments to render medically unnecessary or over utilizing services that result in useless costs to the healthcare system, including healthcare insurance providers. Potential offenders may include patients, hospitals, doctors, vendors, suppliers or even pharmacists.
Here are some facts related to healthcare claims:
- Each year out of the total claims, medical and healthcare industry claims alone account for more than 15 percent of the total false claims.
- Reports suggests that the healthcare industry in India is losing approximately Rs.600 - Rs.800 crores incurred on fraudulent claims annually
Up till now healthcare fraud claims have involved manual work to investigate and identify frauds which has been time consuming and inefficient. The more effective way is to identify frauds in real time, before the claims are paid. Hence there is a need to embrace predictive analysis often used in other industries. This is necessary to prevent scamming, identify inconsistencies and flag them appropriately.
The solution to the problem stated before is to create an AI driven FRAUD DETECTOR Application that would provide protection to the payer by:
- Identifying inconsistencies and potential rule-breaking and hence prevent med-care scamming.
- Providing real-time safety feature to flag out fraud transactions and block them.
- Application can be customized according to the needs and data provided by the organization.
- Data Scrapping and Data analysis for finding the dataset and features that are important for prediction.
- Machine learning is used for flagging the claims according to the dataset and the features.
- Created an API using Flask that can perform the function and hosted it on Heroku.
- Created android application to make the application easy to use.
- Data Analysis and Machine Learning is used for flagging the claims based on the dataset.
- In Android App , Flutter has been used in the front end along with Flask for API.
- Heroku Cloud Service has been used to deploy the web app and API.
- Firebase Services (Authentication, Storage, FireStore) have been used for Backend of the Android application.
- Easy to use: No prior training is required for using the application.
- Adaptability: The application can be easily modified according to the need of the User.
- Time Saving: Application can be used to flag the claims.