摘要 |
An unsupervised method of identifying aberrant behavior by an entity with respect to healthcare claim transactions is provided. A coordinate space is defined with a dimensionality corresponding to a number of selected ranked variables defining a representative behavior of a peer group with respect to a reference source of claim transactions, the peer group comprising a plurality of entites. A central tendency of the representative behavior is then determined from the claim transactions of the reference source, as a result of the selected ranked variables being applied thereto, and with respect to the coordinate space. The selected ranked variables are then applied to a new source of claim transactions for entites corresponding to the peer group so as to define a corresponding element for each entity. After mapping the elements with respect to the coordinate space, a score is then determined for each element with respect to the central tendency. A threshold criteria is then applied to the scores such that a threshold-exceeding score indicates an aberrant behavior by the corresponding entity. An associated computer software program product, computer device, and system are also provided. |
申请人 |
BLOODHOUND SOFTWARE, INC.;ABED, SAMIR, IBRAHIM;WALLACE, MICHAEL, YVAN;SEIB, AARON, MICHAEL;WHIPPLE, DAVID, STANTON;DUBOSE, PAUL, A. |
发明人 |
ABED, SAMIR, IBRAHIM;WALLACE, MICHAEL, YVAN;SEIB, AARON, MICHAEL;WHIPPLE, DAVID, STANTON;DUBOSE, PAUL, A. |