HEALTHCARE FRAUD DETECTION

Visualizations illustrate the impact of fraud on consumption:

-Consumption Amount: Fraudulent claims totaled 19.6 million, while non-fraudulent claims reached 447 million.

- Consumption Percentage: Fraudulent claims represented 4.2% of total consumption, compared to 95.8% for non-fraudulent claims.

- Number of Transactions (TRX): There were 79,356 fraudulent transactions versus 478,855 non-fraudulent transactions.

- Transaction Percentage: Fraudulent transactions accounted for 14.2% of the total, while non-fraudulent transactions comprised 85.8%. .

-These insights underscore the substantial financial impact of fraud on the healthcare system. Visualizing flagged cases provided valuable information on the distribution and characteristics of fraudulent claims, which can enhance fraud detection capabilities within healthcare insurance systems, thereby reducing financial losses and improving industry integrity.

Future efforts could focus on refining fraud detection criteria, integrating additional data sources, and exploring advanced machine learning models to further enhance accuracy and efficiency