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Guide to Machine Learning based Health Care Fraud, Waste and Abuse Detectio...

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Aetna

350 Madison 16th Floor

New York City, NY 10017

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The talk will offer practical advices how to effectively organize and join multiple health care data, how to appropriately set the problem and design an effective machine learning based solution that will not only detect suspicious FWA leads but will also direct investigators through their faster review by providing effective visualization and suggesting most likely reasons behind such leads.

Abstract

According to FBI, estimates for healthcare spending lost due to fraud, waste and abuse (FWA) ranged between $100B and $340B in 2016! At the same time, only the small portion of this money is recovered 2014 from individuals and companies who attempted to defraud various health care programs.

The talk will show how we are developing a comprehensive and intelligent analytical framework for detecting fraudulent, abusive and wasteful claims in near real time using advanced machine learning techniques. The speaker will provide a quick overview of our in-house FWA detection framework and demonstrate how it is used to discover specific FWA scenarios identified in the most recent months. Participants will learn about various health care data sources (in addition to claim data) that are used to detect fraudulent doctors and facilities. In addition, the speaker will offer practical advices how to effectively organize this data, how to adequately design an effective predictive / data analytics solution that will not only detect suspicious FWA leads but will also direct investigators through their faster review by providing effective visualization and suggesting most likely reasons behind such leads.

We have a limited # of seats available for the event. Please be sure to reserve your ticket today!

ABOUT AETNA

Aetna’s mission is to build a healthier world – one person, one family, and one community at a time. In partnership with health care providers, we are committed to driving the health care system forward. The goal is to provide easy access to safe, affordable, high quality health care and help members achieve their best health, however they define it.

ABOUT ANALYTICS & BEHAVIOR CHANGE TEAM

Our Analytics and Behavior Change team is a key component in achieving this mission. We are actively seeking data scientists at all levels to help transform how we think about health and health care.

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Aetna

350 Madison 16th Floor

New York City, NY 10017

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