Electronic fraud detection in the U.S. Medicaid Healthcare Program: lessons learned from other industries

It is estimated that between $600 and$850 billion annually is lost to fraud, waste, and abuse in the US healthcare system,with $125 to$175 billion of this due to fraudulent activity (Kelley 2009). Medicaid, a state-run, federally-matchedgovernment program which accounts for roughly one-quarter of all healthcare expenses in the US, has been particularlysusceptible targets for fraud in recent years. With escalating overall healthcare costs, payers, especially government-runprograms, must seek savings throughout the system to maintain reasonable quality of care standards. As such, the need foreffective fraud detection and prevention is critical. Electronic fraud detection systems are widely used in the insurance,telecommunications, and financial sectors. What lessons can be learned from these efforts and applied to improve frauddetection in the Medicaid health care program? In this paper, we conduct a systematic literature study to analyze theapplicability of existing electronic fraud detection techniques in similar industries to the US Medicaid program

The Minimum Description Length Principle for Pattern Mining: A Survey

This is about the Minimum Description Length (MDL) principle applied to pattern mining. The length of this description is kept to the minimum. Mining patterns is a core task in data analysis and, beyond issues of efficient enumeration, the selection of patterns constitutes a major challenge. The MDL principle, a model selection method grounded in information theory, has been applied to pattern mining with the aim to obtain compact high-quality sets of patterns. After giving an outline of relevant concepts from information theory and coding, as well as of work on the theory behind the MDL and similar principles, we review MDL-based methods for mining various types of data and patterns. Finally, we open a discussion on some issues regarding these methods, and highlight currently active related data analysis problems

Leatherbacks matching by automated image recognition

We describe a method that performs automated recognition of individual laetherback turtles within a large nesting population. With only minimal preprocessing required of the user, we prove able to produce unsupervised matching results. The matching is based on th