{"id":"https://openalex.org/W4378364111","doi":"https://doi.org/10.1109/isdfs58141.2023.10131779","title":"Identification of Providers with Similar Risk Profiles in Healthcare Claims Using Graphs","display_name":"Identification of Providers with Similar Risk Profiles in Healthcare Claims Using Graphs","publication_year":2023,"publication_date":"2023-05-11","ids":{"openalex":"https://openalex.org/W4378364111","doi":"https://doi.org/10.1109/isdfs58141.2023.10131779"},"language":"en","primary_location":{"id":"doi:10.1109/isdfs58141.2023.10131779","is_oa":false,"landing_page_url":"http://dx.doi.org/10.1109/isdfs58141.2023.10131779","pdf_url":null,"source":null,"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"2023 11th International Symposium on Digital Forensics and Security (ISDFS)","raw_type":"proceedings-article"},"type":"conference-paper","indexed_in":["crossref"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5092023127","display_name":"Sal Aguinaga","orcid":null},"institutions":[{"id":"https://openalex.org/I145325580","display_name":"Deloitte (United States)","ror":"https://ror.org/03xkm6e60","country_code":"US","type":"company","lineage":["https://openalex.org/I145325580","https://openalex.org/I4210139068"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Sal Aguinaga","raw_affiliation_strings":["Deloitte Risk & Financial Advisory,AI Center of Excellence,Indianapolis,USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Deloitte Risk & Financial Advisory,AI Center of Excellence,Indianapolis,USA","institution_ids":["https://openalex.org/I145325580"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5092023128","display_name":"Daniel Lasaga","orcid":null},"institutions":[{"id":"https://openalex.org/I145325580","display_name":"Deloitte (United States)","ror":"https://ror.org/03xkm6e60","country_code":"US","type":"company","lineage":["https://openalex.org/I145325580","https://openalex.org/I4210139068"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Daniel Lasaga","raw_affiliation_strings":["Deloitte Risk & Financial Advisory,Program Integrity,New York,USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Deloitte Risk & Financial Advisory,Program Integrity,New York,USA","institution_ids":["https://openalex.org/I145325580"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5092023129","display_name":"Shivashankar Danthuri","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Shivashankar Danthuri","raw_affiliation_strings":["Deloitte Risk & Financial Advisory,AI Center of Excellence,Hyderabad,India"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Deloitte Risk & Financial Advisory,AI Center of Excellence,Hyderabad,India","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5104175070","display_name":"John Helms","orcid":null},"institutions":[{"id":"https://openalex.org/I145325580","display_name":"Deloitte (United States)","ror":"https://ror.org/03xkm6e60","country_code":"US","type":"company","lineage":["https://openalex.org/I145325580","https://openalex.org/I4210139068"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"John Helms","raw_affiliation_strings":["Deloitte Risk & Financial Advisory,AI Center of Excellence,Arlington,USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Deloitte Risk & Financial Advisory,AI Center of Excellence,Arlington,USA","institution_ids":["https://openalex.org/I145325580"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5078074716","display_name":"Edward Bowen","orcid":null},"institutions":[{"id":"https://openalex.org/I145325580","display_name":"Deloitte (United States)","ror":"https://ror.org/03xkm6e60","country_code":"US","type":"company","lineage":["https://openalex.org/I145325580","https://openalex.org/I4210139068"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Edward Bowen","raw_affiliation_strings":["Deloitte Risk & Financial Advisory,AI Center of Excellence,Philadelphia,USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Deloitte Risk & Financial Advisory,AI Center of Excellence,Philadelphia,USA","institution_ids":["https://openalex.org/I145325580"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5064063293","display_name":"Sanmitra Bhattacharya","orcid":"https://orcid.org/0000-0002-1697-3179"},"institutions":[{"id":"https://openalex.org/I145325580","display_name":"Deloitte (United States)","ror":"https://ror.org/03xkm6e60","country_code":"US","type":"company","lineage":["https://openalex.org/I145325580","https://openalex.org/I4210139068"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Sanmitra Bhattacharya","raw_affiliation_strings":["Deloitte Risk & Financial Advisory,AI Center of Excellence,Morristown,USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Deloitte Risk & Financial Advisory,AI Center of Excellence,Morristown,USA","institution_ids":["https://openalex.org/I145325580"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":0.6534,"has_fulltext":false,"cited_by_count":3,"citation_normalized_percentile":{"value":0.66319149,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":{"min":91,"max":96},"biblio":{"volume":"37","issue":null,"first_page":"1","last_page":"6"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11273","display_name":"Advanced Graph Neural Networks","score":0.9916999936103821,"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/T11273","display_name":"Advanced Graph Neural Networks","score":0.9916999936103821,"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/T11860","display_name":"HIV, Drug Use, Sexual Risk","score":0.9301999807357788,"subfield":{"id":"https://openalex.org/subfields/2713","display_name":"Epidemiology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/pairwise-comparison","display_name":"Pairwise comparison","score":0.6984125971794128},{"id":"https://openalex.org/keywords/health-care","display_name":"Health care","score":0.6048450469970703},{"id":"https://openalex.org/keywords/computer-science","display_name":"Computer science","score":0.5484018921852112},{"id":"https://openalex.org/keywords/graph","display_name":"Graph","score":0.4784557819366455},{"id":"https://openalex.org/keywords/similarity","display_name":"Similarity (geometry)","score":0.4233395457267761},{"id":"https://openalex.org/keywords/identification","display_name":"Identification (biology)","score":0.4188881814479828},{"id":"https://openalex.org/keywords/data-mining","display_name":"Data mining","score":0.3902824819087982},{"id":"https://openalex.org/keywords/theoretical-computer-science","display_name":"Theoretical computer science","score":0.24236339330673218},{"id":"https://openalex.org/keywords/artificial-intelligence","display_name":"Artificial intelligence","score":0.2075486183166504}],"concepts":[{"id":"https://openalex.org/C184898388","wikidata":"https://www.wikidata.org/wiki/Q1435712","display_name":"Pairwise comparison","level":2,"score":0.6984125971794128},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.6048450469970703},{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.5484018921852112},{"id":"https://openalex.org/C132525143","wikidata":"https://www.wikidata.org/wiki/Q141488","display_name":"Graph","level":2,"score":0.4784557819366455},{"id":"https://openalex.org/C103278499","wikidata":"https://www.wikidata.org/wiki/Q254465","display_name":"Similarity (geometry)","level":3,"score":0.4233395457267761},{"id":"https://openalex.org/C116834253","wikidata":"https://www.wikidata.org/wiki/Q2039217","display_name":"Identification (biology)","level":2,"score":0.4188881814479828},{"id":"https://openalex.org/C124101348","wikidata":"https://www.wikidata.org/wiki/Q172491","display_name":"Data mining","level":1,"score":0.3902824819087982},{"id":"https://openalex.org/C80444323","wikidata":"https://www.wikidata.org/wiki/Q2878974","display_name":"Theoretical computer science","level":1,"score":0.24236339330673218},{"id":"https://openalex.org/C154945302","wikidata":"https://www.wikidata.org/wiki/Q11660","display_name":"Artificial intelligence","level":1,"score":0.2075486183166504},{"id":"https://openalex.org/C59822182","wikidata":"https://www.wikidata.org/wiki/Q441","display_name":"Botany","level":1,"score":0.0},{"id":"https://openalex.org/C86803240","wikidata":"https://www.wikidata.org/wiki/Q420","display_name":"Biology","level":0,"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/C115961682","wikidata":"https://www.wikidata.org/wiki/Q860623","display_name":"Image (mathematics)","level":2,"score":0.0}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.1109/isdfs58141.2023.10131779","is_oa":false,"landing_page_url":"http://dx.doi.org/10.1109/isdfs58141.2023.10131779","pdf_url":null,"source":null,"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"2023 11th International Symposium on Digital Forensics and Security (ISDFS)","raw_type":"proceedings-article"}],"best_oa_location":null,"sustainable_development_goals":[{"score":0.75,"display_name":"Peace, Justice and strong institutions","id":"https://metadata.un.org/sdg/16"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":21,"referenced_works":["https://openalex.org/W1958560088","https://openalex.org/W2037757210","https://openalex.org/W2069870183","https://openalex.org/W2090891622","https://openalex.org/W2113640060","https://openalex.org/W2154851992","https://openalex.org/W2403048220","https://openalex.org/W2495589275","https://openalex.org/W2562873640","https://openalex.org/W2743104969","https://openalex.org/W2797309297","https://openalex.org/W2952343887","https://openalex.org/W2975640305","https://openalex.org/W2986486878","https://openalex.org/W3104097132","https://openalex.org/W3114928288","https://openalex.org/W3126138172","https://openalex.org/W3138089704","https://openalex.org/W3174753721","https://openalex.org/W6768207446","https://openalex.org/W6779680381"],"related_works":["https://openalex.org/W2487162673","https://openalex.org/W2793211469","https://openalex.org/W2949152769","https://openalex.org/W4372354731","https://openalex.org/W2942366970","https://openalex.org/W2807634898","https://openalex.org/W1692008701","https://openalex.org/W2597588799","https://openalex.org/W4360593462","https://openalex.org/W2562400057"],"abstract_inverted_index":{"Fraud,":[0],"waste,":[1],"and":[2,21,65,82,113,136],"abuse":[3],"(FWA)":[4],"in":[5,102,151],"healthcare":[6,79],"claims":[7],"pose":[8],"challenges":[9],"to":[10,18,61,91,123,139,144],"the":[11,23,103,133,146],"accessibility":[12],"of":[13,25,32,44,58,118,148],"healthcare,":[14],"adds":[15],"a":[16,29,74,115,124],"burden":[17],"health":[19],"expenditures,":[20],"diminishes":[22],"quality":[24],"care.":[26],"There":[27],"is":[28,57],"wide":[30],"variety":[31],"fraudulent":[33,55],"behavior":[34],"among":[35],"providers,":[36],"which":[37],"necessitates":[38],"lengthy":[39],"investigative":[40],"efforts.":[41],"Timely":[42],"identification":[43],"providers":[45,56,119,153],"who":[46,120,160],"share":[47],"traits":[48],"with":[49,73,154],"other":[50],"high":[51],"risk":[52,84,156],"or":[53],"potentially":[54],"great":[59],"importance":[60],"help":[62],"curb":[63],"FWA":[64],"expedite":[66],"investigations.":[67],"In":[68],"this":[69,97],"paper,":[70],"we":[71,105],"experiment":[72],"graph":[75,104],"topology":[76],"built":[77],"on":[78,132],"claim-level":[80],"features":[81],"provider":[83,93,101],"indicators.":[85],"Graph":[86],"neural":[87],"networks":[88],"are":[89,121,161],"used":[90],"compute":[92,106,128],"node":[94],"embeddings":[95],"from":[96],"graph.":[98],"For":[99],"each":[100],"pairwise":[107],"similarity":[108,111],"using":[109],"vector":[110],"methods,":[112],"create":[114],"rank":[116],"order":[117],"similar":[122,155],"given":[125],"provider.":[126],"We":[127],"rank-based":[129],"performance":[130],"metrics":[131],"predicted":[134],"rankings":[135,143],"compare":[137],"them":[138],"subject":[140],"matter":[141],"specialist":[142],"show":[145],"effectiveness":[147],"our":[149],"models":[150],"discerning":[152],"profiles":[157],"versus":[158],"those":[159],"dissimilar.":[162]},"counts_by_year":[{"year":2025,"cited_by_count":1},{"year":2023,"cited_by_count":2}],"updated_date":"2026-07-29T14:22:42.915294","created_date":"2025-10-10T00:00:00"}