{"id":"https://openalex.org/W3047216992","doi":"https://doi.org/10.1109/access.2020.3013962","title":"Sequence Mining and Prediction-Based Healthcare Fraud Detection Methodology","display_name":"Sequence Mining and Prediction-Based Healthcare Fraud Detection Methodology","publication_year":2020,"publication_date":"2020-01-01","ids":{"openalex":"https://openalex.org/W3047216992","doi":"https://doi.org/10.1109/access.2020.3013962","mag":"3047216992"},"language":"en","primary_location":{"id":"doi:10.1109/access.2020.3013962","is_oa":true,"landing_page_url":"https://doi.org/10.1109/access.2020.3013962","pdf_url":"https://ieeexplore.ieee.org/ielx7/6287639/8948470/09154698.pdf","source":{"id":"https://openalex.org/S2485537415","display_name":"IEEE Access","issn_l":"2169-3536","issn":["2169-3536"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310319808","host_organization_name":"Institute of Electrical and Electronics Engineers","host_organization_lineage":["https://openalex.org/P4310319808"],"host_organization_lineage_names":["Institute of Electrical and Electronics Engineers"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"IEEE Access","raw_type":"journal-article"},"type":"article","indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://ieeexplore.ieee.org/ielx7/6287639/8948470/09154698.pdf","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5016362237","display_name":"Irum Matloob","orcid":"https://orcid.org/0000-0002-5425-2321"},"institutions":[{"id":"https://openalex.org/I929597975","display_name":"National University of Sciences and Technology","ror":"https://ror.org/03w2j5y17","country_code":"PK","type":"education","lineage":["https://openalex.org/I929597975"]}],"countries":["PK"],"is_corresponding":true,"raw_author_name":"Irum Matloob","raw_affiliation_strings":["Department of Computer and Software Engineering, College of Electrical and Mechanical Engineering (CEME), National University of Sciences and Technology (NUST), Islamabad, Pakistan"],"affiliations":[{"raw_affiliation_string":"Department of Computer and Software Engineering, College of Electrical and Mechanical Engineering (CEME), National University of Sciences and Technology (NUST), Islamabad, Pakistan","institution_ids":["https://openalex.org/I929597975"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5050441398","display_name":"Shoab Ahmed Khan","orcid":"https://orcid.org/0000-0003-0265-8204"},"institutions":[{"id":"https://openalex.org/I929597975","display_name":"National University of Sciences and Technology","ror":"https://ror.org/03w2j5y17","country_code":"PK","type":"education","lineage":["https://openalex.org/I929597975"]}],"countries":["PK"],"is_corresponding":false,"raw_author_name":"Shoab Ahmed Khan","raw_affiliation_strings":["Department of Computer and Software Engineering, College of Electrical and Mechanical Engineering (CEME), National University of Sciences and Technology (NUST), Islamabad, Pakistan"],"affiliations":[{"raw_affiliation_string":"Department of Computer and Software Engineering, College of Electrical and Mechanical Engineering (CEME), National University of Sciences and Technology (NUST), Islamabad, Pakistan","institution_ids":["https://openalex.org/I929597975"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5101706843","display_name":"H. Rahman","orcid":"https://orcid.org/0000-0002-2554-849X"},"institutions":[{"id":"https://openalex.org/I4210116838","display_name":"Shifa International Hospital","ror":"https://ror.org/02en8ya84","country_code":"PK","type":"healthcare","lineage":["https://openalex.org/I4210116838"]}],"countries":["PK"],"is_corresponding":false,"raw_author_name":"Habib Ur Rahman","raw_affiliation_strings":["Department of Cardiology, Shifa International Hospital, Islamabad, Pakistan"],"affiliations":[{"raw_affiliation_string":"Department of Cardiology, Shifa International Hospital, Islamabad, Pakistan","institution_ids":["https://openalex.org/I4210116838"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":3,"corresponding_author_ids":["https://openalex.org/A5016362237"],"corresponding_institution_ids":["https://openalex.org/I929597975"],"apc_list":{"value":1850,"currency":"USD","value_usd":1850},"apc_paid":{"value":1850,"currency":"USD","value_usd":1850},"fwci":2.8974,"has_fulltext":true,"cited_by_count":43,"citation_normalized_percentile":{"value":0.92585044,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":89,"max":100},"biblio":{"volume":"8","issue":null,"first_page":"143256","last_page":"143273"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11652","display_name":"Imbalanced Data Classification Techniques","score":0.9994000196456909,"subfield":{"id":"https://openalex.org/subfields/1702","display_name":"Artificial Intelligence"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},"topics":[{"id":"https://openalex.org/T11652","display_name":"Imbalanced Data Classification Techniques","score":0.9994000196456909,"subfield":{"id":"https://openalex.org/subfields/1702","display_name":"Artificial Intelligence"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T10538","display_name":"Data Mining Algorithms and Applications","score":0.9966999888420105,"subfield":{"id":"https://openalex.org/subfields/1710","display_name":"Information Systems"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T11396","display_name":"Artificial Intelligence in Healthcare","score":0.9595999717712402,"subfield":{"id":"https://openalex.org/subfields/3605","display_name":"Health Information Management"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/computer-science","display_name":"Computer science","score":0.6823184490203857},{"id":"https://openalex.org/keywords/health-care","display_name":"Health care","score":0.5800512433052063},{"id":"https://openalex.org/keywords/sequence","display_name":"Sequence (biology)","score":0.5149572491645813},{"id":"https://openalex.org/keywords/data-mining","display_name":"Data mining","score":0.4895823895931244},{"id":"https://openalex.org/keywords/artificial-intelligence","display_name":"Artificial intelligence","score":0.3266952633857727}],"concepts":[{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.6823184490203857},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.5800512433052063},{"id":"https://openalex.org/C2778112365","wikidata":"https://www.wikidata.org/wiki/Q3511065","display_name":"Sequence (biology)","level":2,"score":0.5149572491645813},{"id":"https://openalex.org/C124101348","wikidata":"https://www.wikidata.org/wiki/Q172491","display_name":"Data mining","level":1,"score":0.4895823895931244},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.3266952633857727},{"id":"https://openalex.org/C54355233","wikidata":"https://www.wikidata.org/wiki/Q7162","display_name":"Genetics","level":1,"score":0.0},{"id":"https://openalex.org/C50522688","wikidata":"https://www.wikidata.org/wiki/Q189833","display_name":"Economic growth","level":1,"score":0.0},{"id":"https://openalex.org/C162324750","wikidata":"https://www.wikidata.org/wiki/Q8134","display_name":"Economics","level":0,"score":0.0},{"id":"https://openalex.org/C86803240","wikidata":"https://www.wikidata.org/wiki/Q420","display_name":"Biology","level":0,"score":0.0}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.1109/access.2020.3013962","is_oa":true,"landing_page_url":"https://doi.org/10.1109/access.2020.3013962","pdf_url":"https://ieeexplore.ieee.org/ielx7/6287639/8948470/09154698.pdf","source":{"id":"https://openalex.org/S2485537415","display_name":"IEEE Access","issn_l":"2169-3536","issn":["2169-3536"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310319808","host_organization_name":"Institute of Electrical and Electronics Engineers","host_organization_lineage":["https://openalex.org/P4310319808"],"host_organization_lineage_names":["Institute of Electrical and Electronics Engineers"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"IEEE Access","raw_type":"journal-article"},{"id":"pmh:oai:doaj.org/article:d33808133fd54a7ea9cefd1803391396","is_oa":true,"landing_page_url":"https://doaj.org/article/d33808133fd54a7ea9cefd1803391396","pdf_url":null,"source":{"id":"https://openalex.org/S112646816","display_name":"SHILAP Revista de lepidopterolog\u00eda","issn_l":"0300-5267","issn":["0300-5267","2340-4078"],"is_oa":true,"is_in_doaj":true,"is_core":false,"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":"cc-by-sa","license_id":"https://openalex.org/licenses/cc-by-sa","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"IEEE Access, Vol 8, Pp 143256-143273 (2020)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.1109/access.2020.3013962","is_oa":true,"landing_page_url":"https://doi.org/10.1109/access.2020.3013962","pdf_url":"https://ieeexplore.ieee.org/ielx7/6287639/8948470/09154698.pdf","source":{"id":"https://openalex.org/S2485537415","display_name":"IEEE Access","issn_l":"2169-3536","issn":["2169-3536"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310319808","host_organization_name":"Institute of Electrical and Electronics Engineers","host_organization_lineage":["https://openalex.org/P4310319808"],"host_organization_lineage_names":["Institute of Electrical and Electronics Engineers"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"IEEE Access","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Peace, Justice and strong institutions","id":"https://metadata.un.org/sdg/16","score":0.7099999785423279}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W3047216992.pdf","grobid_xml":"https://content.openalex.org/works/W3047216992.grobid-xml"},"referenced_works_count":49,"referenced_works":["https://openalex.org/W24562363","https://openalex.org/W1484413656","https://openalex.org/W1493425711","https://openalex.org/W1608194207","https://openalex.org/W1973545388","https://openalex.org/W1980042725","https://openalex.org/W1990557724","https://openalex.org/W1990800901","https://openalex.org/W1991475418","https://openalex.org/W1998619381","https://openalex.org/W2005464046","https://openalex.org/W2011430131","https://openalex.org/W2017733151","https://openalex.org/W2032623688","https://openalex.org/W2040401127","https://openalex.org/W2040714331","https://openalex.org/W2074980655","https://openalex.org/W2096256884","https://openalex.org/W2110893883","https://openalex.org/W2132502528","https://openalex.org/W2133841540","https://openalex.org/W2146606092","https://openalex.org/W2148061495","https://openalex.org/W2158396349","https://openalex.org/W2158454296","https://openalex.org/W2168196587","https://openalex.org/W2184719144","https://openalex.org/W2214709429","https://openalex.org/W2248204980","https://openalex.org/W2363917130","https://openalex.org/W2400311702","https://openalex.org/W2609571025","https://openalex.org/W2734863171","https://openalex.org/W2755041628","https://openalex.org/W2786577118","https://openalex.org/W2787707077","https://openalex.org/W2794652412","https://openalex.org/W2879824767","https://openalex.org/W2915146239","https://openalex.org/W2973232334","https://openalex.org/W3000561819","https://openalex.org/W3017833093","https://openalex.org/W3146200671","https://openalex.org/W3204739509","https://openalex.org/W4211139099","https://openalex.org/W6628750762","https://openalex.org/W6629486220","https://openalex.org/W6645198707","https://openalex.org/W6802582845"],"related_works":["https://openalex.org/W4391375266","https://openalex.org/W2748952813","https://openalex.org/W2390279801","https://openalex.org/W2358668433","https://openalex.org/W2376932109","https://openalex.org/W2001405890","https://openalex.org/W2382290278","https://openalex.org/W4395014643","https://openalex.org/W4391913857","https://openalex.org/W2350741829"],"abstract_inverted_index":{"This":[0],"article":[1],"presents":[2],"a":[3,29,62,227],"novel":[4],"methodology":[5,94,123,213,258,265],"to":[6,33,64,97,177,188,237,251,268,292],"detect":[7,269],"insurance":[8,118],"claim":[9,119],"related":[10,120],"frauds":[11,271],"in":[12,26,199,206,282],"the":[13,34,47,74,115,164,172,178,189,192,207,253,256,260,264],"healthcare":[14,27,38,270],"system":[15,196],"using":[16,239],"concepts":[17],"of":[18,37,49,56,76,100,117,157,163,168,180,191,226,233,255,277],"sequence":[19,22,70,149],"mining":[20],"and":[21,45,108,127,144,155,230,242,259,272,286,296],"prediction.":[23],"Fraud":[24],"detection":[25,67,116],"is":[28,61,72,95,135,214,266],"non-trivial":[30],"task":[31],"due":[32],"heterogeneous":[35],"nature":[36],"records.":[39,133],"Fraudsters":[40],"behave":[41],"as":[42,182],"normal":[43],"patients":[44,238],"with":[46,171],"passage":[48],"time":[50],"keep":[51],"on":[52,82,137,202,274],"changing":[53],"their":[54],"way":[55],"planting":[57],"frauds;":[58],"hence,":[59],"there":[60],"need":[63],"develop":[65],"fraud":[66],"models.":[68],"The":[69,92,122,148,166,195,211],"generation":[71],"not":[73,186],"part":[75],"previous":[77],"researches":[78],"which":[79],"mostly":[80],"focus":[81],"amount":[83],"based":[84,136,146,209],"analysis":[85,201],"or":[86,103],"medication":[87],"versus":[88],"diseases":[89],"sequential":[90],"analysis.":[91],"proposed":[93,212],"able":[96],"generate":[98],"sequences":[99,154,159,170,175,184,190,205,219],"services":[101],"availed":[102],"prescribed":[104],"by":[105,216],"each":[106,161],"specialty":[107,162],"analyse":[109],"via":[110],"two":[111,138],"cascaded":[112],"checks":[113],"for":[114,160],"frauds.":[121],"addresses":[124],"these":[125],"challenges":[126],"self":[128],"learns":[129],"from":[130,220],"historical":[131],"medical":[132],"It":[134],"modules":[139],"namely":[140],"\u201cSequence":[141],"rule":[142,150,193],"engine":[143,151],"Prediction":[145],"engine\u201d.":[147],"generates":[152],"frequent":[153],"probabilities":[156],"rare":[158],"hospital.":[165],"comparison":[167],"such":[169],"actual":[173],"patient":[174,218,294],"leads":[176],"identification":[179],"anomalies":[181],"both":[183],"are":[185],"compliant":[187],"engine.":[194,210],"performs":[197],"further":[198],"detail":[200],"all":[203],"non-compliant":[204],"prediction":[208,244],"validated":[215],"generating":[217],"last":[221],"five":[222],"years":[223],"transactional":[224],"data":[225],"local":[228],"hospital":[229],"identifies":[231],"patterns":[232],"service":[234],"procedures":[235],"administered":[236],"Prefixspan":[240],"algorithm":[241],"Compact":[243],"tree.":[245],"Various":[246],"experiments":[247],"have":[248],"been":[249],"performed":[250],"validate":[252],"applicability":[254],"developed":[257],"results":[261],"demonstrate":[262],"that":[263],"pertinent":[267],"provides":[273,287],"average":[275],"85%":[276],"accuracy.":[278],"Thus":[279],"can":[280],"help":[281],"preventing":[283],"fraudulent":[284],"claims":[285],"better":[288],"insight":[289],"into":[290],"how":[291],"improve":[293],"management":[295],"treatment":[297],"procedures.":[298]},"counts_by_year":[{"year":2026,"cited_by_count":1},{"year":2025,"cited_by_count":13},{"year":2024,"cited_by_count":8},{"year":2023,"cited_by_count":4},{"year":2022,"cited_by_count":12},{"year":2021,"cited_by_count":4},{"year":2020,"cited_by_count":1}],"updated_date":"2026-04-02T15:55:50.835912","created_date":"2025-10-10T00:00:00"}
