부산대학교 도서관

To address the complex issues of detecting fraudulent practices in healthcare insurance, this research employs sophisticated machine learning, especially the Long Short-Term Memory (LSTM) model, to provide a complete framework for reliable fraud detection. The study meticulously examines performance metrics such as accuracy, precision, recall, and the F1 score by employing and evaluating the LSTM model across two distinct datasets-Dataset A (198810 samples) and Dataset B (434319 samples)-illuminating the model's capacity to detect fraudulent activities while minimizing misclassifications. The evaluation process, as shown by confusion matrices displayed as percentages, reveals the model's strengths and points up areas for improvement. This study makes an important contribution to the field of fraud detection by providing practical insights to strengthen healthcare insurance against misleading practices. This research proclaimers a paradigm shift by combining innovative methodologies, extensive dataset curation, and stringent evaluation, ushering in increased security, transparency, and efficacy in healthcare insurance fraud detection, ultimately fostering a future of resilient and precise fraud detection mechanisms.