| 摘要 |
<p>Transition probability sequencing models and metrics are derived from healthcare claims data (100, Fig.1) to identify potentially fraudulent or abusive practices, providers, doctors, clients, or other entities. Healthcare reimbursement claims from hospitals, skilled nursing facilities, doctors, etc., are processed to identify sequences of states, and transition probability metrics are determined from frequency information pertaining to the states. The metrics can these be further analyzed in predictive (4, Fig.1) or rule based models (5, Fig.1), or other tools.</p> |
