FRAUD AND ABUSE DETECTION AND ENTITY PROFILING IN HIERARCHICAL CODED PAYMENT SYSTEMS

摘要

Fraud and abuse detection in an entity's payment coding practices includes the ability to search for fraud at all levels of the hierarchical coded payment system within the context of an unsupervised model. The model uses variables derived and profiles created at any level or at all levels of the hierarchical coded payment system to create a comprehensive description of the payment coding activities submitted by the entity. That description is compared with other peer entities to determine unusual and To potentially inappropriate activity. The profiles created may themselves be utilized for purposes other than the detection of fraud and abuse.