{"id":"https://openalex.org/W2005321422","doi":"https://doi.org/10.4304/jnw.9.7.1798-1802","title":"Using CommonKADS Method to Build Prototype System in Medical Insurance Fraud Detection","display_name":"Using CommonKADS Method to Build Prototype System in Medical Insurance Fraud Detection","publication_year":2014,"publication_date":"2014-07-03","ids":{"openalex":"https://openalex.org/W2005321422","doi":"https://doi.org/10.4304/jnw.9.7.1798-1802","mag":"2005321422"},"language":"en","primary_location":{"id":"doi:10.4304/jnw.9.7.1798-1802","is_oa":false,"landing_page_url":"https://doi.org/10.4304/jnw.9.7.1798-1802","pdf_url":null,"source":{"id":"https://openalex.org/S189188848","display_name":"Journal of Networks","issn_l":"1796-2056","issn":["1796-2056"],"is_oa":false,"is_in_doaj":false,"is_core":true,"host_organization":"https://openalex.org/P4310318660","host_organization_name":"Academy Publisher","host_organization_lineage":["https://openalex.org/P4310318660"],"host_organization_lineage_names":["Academy Publisher"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Networks","raw_type":"journal-article"},"type":"article","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/A5069356451","display_name":"Yao-Hsu Tsai","orcid":"https://orcid.org/0000-0001-6104-2472"},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Yao-Hsu Tsai","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5035185853","display_name":"Chieh-Heng Ko","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Chieh-Heng Ko","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"last","author":{"id":"https://openalex.org/A5064766164","display_name":"Kuo-Chung Lin","orcid":null},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Kuo-Chung Lin","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":3,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":4.2291,"has_fulltext":false,"cited_by_count":19,"citation_normalized_percentile":{"value":0.94294554,"is_in_top_1_percent":false,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":90,"max":98},"biblio":{"volume":"9","issue":"7","first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11652","display_name":"Imbalanced Data Classification Techniques","score":0.9987999796867371,"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":0.9987999796867371,"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":0.9865000247955322,"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/T11063","display_name":"Rough Sets and Fuzzy Logic","score":0.9710999727249146,"subfield":{"id":"https://openalex.org/subfields/1703","display_name":"Computational Theory and Mathematics"},"field":{"id":"https://openalex.org/fields/17","display_name":"Computer Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/computer-science","display_name":"Computer science","score":0.9200679063796997},{"id":"https://openalex.org/keywords/medical-insurance","display_name":"Medical insurance","score":0.4750649631023407},{"id":"https://openalex.org/keywords/computer-security","display_name":"Computer security","score":0.3564090132713318},{"id":"https://openalex.org/keywords/actuarial-science","display_name":"Actuarial science","score":0.09269335865974426}],"concepts":[{"id":"https://openalex.org/C41008148","wikidata":"https://www.wikidata.org/wiki/Q21198","display_name":"Computer science","level":0,"score":0.9200679063796997},{"id":"https://openalex.org/C2991717224","wikidata":"https://www.wikidata.org/wiki/Q334911","display_name":"Medical insurance","level":2,"score":0.4750649631023407},{"id":"https://openalex.org/C38652104","wikidata":"https://www.wikidata.org/wiki/Q3510521","display_name":"Computer security","level":1,"score":0.3564090132713318},{"id":"https://openalex.org/C162118730","wikidata":"https://www.wikidata.org/wiki/Q1128453","display_name":"Actuarial science","level":1,"score":0.09269335865974426},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.0}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.4304/jnw.9.7.1798-1802","is_oa":false,"landing_page_url":"https://doi.org/10.4304/jnw.9.7.1798-1802","pdf_url":null,"source":{"id":"https://openalex.org/S189188848","display_name":"Journal of Networks","issn_l":"1796-2056","issn":["1796-2056"],"is_oa":false,"is_in_doaj":false,"is_core":true,"host_organization":"https://openalex.org/P4310318660","host_organization_name":"Academy Publisher","host_organization_lineage":["https://openalex.org/P4310318660"],"host_organization_lineage_names":["Academy Publisher"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Networks","raw_type":"journal-article"}],"best_oa_location":null,"sustainable_development_goals":[{"display_name":"Decent work and economic growth","score":0.5,"id":"https://metadata.un.org/sdg/8"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":16,"referenced_works":["https://openalex.org/W155535615","https://openalex.org/W274386851","https://openalex.org/W1506818785","https://openalex.org/W1523712082","https://openalex.org/W1602011302","https://openalex.org/W1963731024","https://openalex.org/W1974006526","https://openalex.org/W1978920435","https://openalex.org/W2006640216","https://openalex.org/W2064910157","https://openalex.org/W2137728546","https://openalex.org/W2140190241","https://openalex.org/W2319873330","https://openalex.org/W2798326610","https://openalex.org/W4248650647","https://openalex.org/W4299681303"],"related_works":["https://openalex.org/W2899084033","https://openalex.org/W2748952813","https://openalex.org/W2390279801","https://openalex.org/W2358668433","https://openalex.org/W2376932109","https://openalex.org/W2382290278","https://openalex.org/W2350741829","https://openalex.org/W2130043461","https://openalex.org/W2530322880","https://openalex.org/W1596801655"],"abstract_inverted_index":{"At":[0],"present,":[1],"the":[2,25,54,71,85,102,109,114,122,135,144,152,159,166],"false":[3],"claim":[4],"cases":[5,17],"related":[6],"to":[7,44,65,83,94,133],"insurance":[8,20],"fraud":[9,16],"emerge":[10],"endlessly.":[11],"In":[12,76],"respect":[13],"of":[14,18,40,52,56,58,68,73,138,151,162],"frequent":[15],"social":[19,74],"undertaken":[21],"by":[22,121],"government":[23],"organizations,":[24],"inspection":[26],"procedure":[27],"usually":[28],"relies":[29],"on":[30],"experts\u2019":[31],"experience":[32],"for":[33],"verification":[34],"and":[35,50,70,97,105,148,156],"experienced":[36],"personnel":[37],"in":[38,165],"charge":[39],"checking.":[41],"However,":[42],"due":[43],"heavy":[45],"work":[46],"load":[47],"insufficient":[48],"manpower":[49],"lack":[51],"experience,":[53],"ratio":[55],"miscarriages":[57],"justice":[59],"is":[60],"very":[61],"high,":[62],"which":[63],"leads":[64],"improper":[66],"settlement":[67],"claims":[69],"waste":[72],"resources.":[75],"this":[77],"paper,":[78],"we":[79],"used":[80],"rule":[81],"technology":[82],"improve":[84],"above":[86],"inefficiency.":[87],"We":[88,107],"employ":[89],"a":[90,127],"knowledge":[91,99,110,128],"engineering":[92],"methodology":[93],"analyze":[95],"problems":[96,137],"construct":[98],"modesl,":[100],"including":[101],"domain":[103],"schema":[104],"rules.":[106],"implement":[108],"model":[111],"along":[112],"with":[113,130],"existing":[115,153],"database":[116,164],"applications.":[117],"The":[118],"benefits":[119],"generated":[120],"research":[123],"are:":[124],"(1)":[125],"establishing":[126],"system":[129],"expertise":[131],"reasoning":[132,168],"solve":[134],"review":[136],"massive":[139],"cases,":[140],"(2)":[141],"significantly":[142],"reducing":[143],"large":[145],"labor":[146],"cost":[147],"consumed":[149],"time":[150],"reviewing":[154],"system,":[155],"(3)":[157],"improving":[158],"application":[160],"level":[161],"traditional":[163],"expert":[167],"system.":[169]},"counts_by_year":[{"year":2024,"cited_by_count":2},{"year":2023,"cited_by_count":1},{"year":2022,"cited_by_count":1},{"year":2020,"cited_by_count":2},{"year":2019,"cited_by_count":1},{"year":2018,"cited_by_count":2},{"year":2017,"cited_by_count":5},{"year":2016,"cited_by_count":3},{"year":2015,"cited_by_count":2}],"updated_date":"2026-06-11T09:08:48.828518","created_date":"2025-10-10T00:00:00"}
