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Blockchain as a Healthcare Insurance Fraud Detection Tool

Abstract:

Healthcare insurance is intended to help pay for the insured’s medical expenses by paying a policy premium. For this, the industry needs the collaboration of some entities, such as: doctors, health care centers, brokers, insurers, reinsurers. In this context, gathering the information necessary to assess and process claims is a major problem. As a consequence, these inconveniences are exploited by fraudsters and scammers. Faced with these challenges, blockchain can help solve them. This paper defines blockchain and investigates how its inherent characteristics can contribute to detecting healthcare insurance fraud. Then, a layered overview and model using smart contracts are defined. Finally, conclusions and recommendations are issued to address its implementation in the insurance market.