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Unsupervised DRG upcoding detection in healthcare databases

Luo, Wei and Gallagher, Marcus 2010, Unsupervised DRG upcoding detection in healthcare databases, in ICDMW 2010 : Proceedings of 10th IEEE International Conference on Data Mining Workshops, IEEE Computer Society, Sydney, N.S.W., pp. 600-605.

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Title Unsupervised DRG upcoding detection in healthcare databases
Author(s) Luo, WeiORCID iD for Luo, Wei orcid.org/0000-0002-4711-7543
Gallagher, Marcus
Conference name International Conference on Data Mining Workshops (10th : 2010 : Sydney, N.S.W.)
Conference location Sydney, New South Wales
Conference dates 14-17 Dec. 2010
Title of proceedings ICDMW 2010 : Proceedings of 10th IEEE International Conference on Data Mining Workshops
Editor(s) Fan, Wei
Hsu, Wynne
Webb, Geoffrey I.
Liu, Bing
Zhang, Chengqi
Gunopulos, Dimitrios
Wu, Xindong
Publication date 2010
Conference series International Conference on Data Mining Workshops
Start page 600
End page 605
Total pages 6
Publisher IEEE Computer Society
Place of publication Sydney, N.S.W.
Keyword(s) DRG upcoding
decision tree
healthcare data
Fisher’s exact test
Summary Diagnosis Related Group (DRG) upcoding is an anomaly in healthcare data that costs hundreds of millions of dollars in many developed countries. DRG upcoding is typically detected through resource intensive auditing. As supervised modeling of DRG upcoding is severely constrained by scope and timeliness of past audit data, we propose in this paper an unsupervised algorithm to filter data for potential identification of DRG upcoding. The algorithm has been applied to a hip replacement/revision dataset and a heart-attack dataset. The results are consistent with the assumptions held by domain experts.
ISBN 9780769542577
Language eng
Field of Research 080109 Pattern Recognition and Data Mining
Socio Economic Objective 970108 Expanding Knowledge in the Information and Computing Sciences
HERDC Research category E1.1 Full written paper - refereed
Copyright notice ©2010, IEEE
Free to Read? Yes
Persistent URL http://hdl.handle.net/10536/DRO/DU:30052497

Document type: Conference Paper
Collections: Centre for Pattern Recognition and Data Analytics
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.