Bima Journal : Business, Management and Accounting Journal
Vol. 5 No. 2 (2024)

A Systematic Literature Review of Artificial Intelligence In Detecting Fraud in Health Insurance

Syahrudin, Muhammad (Unknown)



Article Info

Publish Date
28 Dec 2024

Abstract

Purpose: The purpose of this study is to find out how research on fraud in the world of health insurance is developing and how fraud can be detected. Methodology: The Systematic Literature Review (SLR) method was used by researchers to answer the Research Question (RQ) in this study Results: Research on fraud in health insurance has grown significantly over the past decade, several types of fraud often occur in health insurance such as Upcoding, fragmentation, repeat billing, fake reimbursement and the use of AI can help detect fraud  Findings: Artificial Intelligence can help detect fraud so that it can help prevent losses that will be experienced by the company. Novelty: Watase Uake software is used in this study's systematic literature review approach to examine global health insurance fraud from a variety of reference sources. Originality: This study provides an empirical analysis of how the role of Artificial Intelligence in detecting fraud and the development of research related to fraud in the world of health insurance. Conclusion: Research on fraud in health insurance has grown significantly over the past decade, several types of fraud that often occur in health insurance such as upcoding, fake reimbursement, repeat billing and fragmentation. the use of AI can help detect fraud and It is hoped that future research can examine how AI can evolve in detecting fraud. Type of Paper : Empirical research Paper

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Journal Info

Abbrev

bima

Publisher

Subject

Decision Sciences, Operations Research & Management Economics, Econometrics & Finance

Description

BIMA Journal is a scientific communication media which is issued by PDM Bengkulu. It is the contribution to the development of social science, business, accounting, and economy which is divided into the English Language which contains research results, literature review, field cases, or concepts. ...