Fraud detection in healthcare claims using machine learning: A systematic review

Anli du Preez, Sanmitra Bhattacharya, Peter A. Beling, Edward Bowen

Abstract: Highlights•This survey paper provides a systematic review of healthcare fraud detection.•Healthcare fraud detection is challenging due to scarce fraudulent cases.•Various machine learning approaches have been used for healthcare fraud detection.•Unsupervised, supervised and hybrid approaches has been applied.•Advanced machine learning methods and explainable artificial intelligence is advised.