ACADSTAFF UGM

CREATION
Title : Anomaly Detection in Hospital Claims Using K-Means and Linear Regression
Author :

HENDRI KURNIAWAN P (1) Dr. Nur Rokhman, S.Si., M.Kom. (2)
Date : 31 2021
Keyword : Deteksi , Anomali , BPJS - Kesehatan , K - Means, Regresi Linear Deteksi , Anomali , BPJS - Kesehatan , K - Means, Regresi Linear
Abstract : BPJS Kesehatan, which has been in existence for almost a decade, is still experiencing a deficit in the process of guaranteeing participants. One of the factors that causes this is a discrepancy in the claim process which tends to harm BPJS Kesehatan. For example, by increasing the diagnostic coding so that the claim becomes bigger, making double claims or even recording false claims. These actions are based on government regulations is including fraud. Fraud can be detected by looking at the anomalies that appear in the claim data. This research aims to determine the anomaly of hospital claim to BPJS Kesehatan. The data used is BPJS claim data for 2015-2016. While the algorithm used is a combination of K-Means algorithm and Linear Regression. For optimal clustering results, the density canopy algorithm was used to determine the initial centroid. The results of the evaluation of the cluster reached optimal conditions with a silhouette index value of 0.806. The average RMSE value calculated by simple linear regression is 3.17, resulting in 823 anomaly points from 10,000 data or 8.23%. Knowing the anomalies in the data is expected to be an early warning for BPJS Kesehatan against any indications of fraud.
Group of Knowledge : Ilmu Komputer
Original Language : English
Level : Nasional
Status :
Published
Document
No Title Document Type Action
1 Dokumen IJCCS 2021 10 merged-pdf-2022-09-04T09_00_47.pdf
Document Type : [PAK] Full Dokumen
[PAK] Full Dokumen View
2 Halaman -Sampul IJCCS (Indonesian Journal of Computing and Cybernetics Systems).pdf
Document Type : [PAK] Halaman Cover
[PAK] Halaman Cover View
3 Editorial Team-IJCCS.pdf
Document Type : [PAK] Halaman Editorial
[PAK] Halaman Editorial View
4 DAftar Isi - Vol 15, No 4 (2021).pdf
Document Type : [PAK] Daftar Isi
[PAK] Daftar Isi View
5 Sertifikat akreditasi IJCCS.pdf
Document Type : Dokumen Pendukung Karya Ilmiah (Hibah, Publikasi, Penelitian, Pengabdian)
Dokumen Pendukung Karya Ilmiah (Hibah, Publikasi, Penelitian, Pengabdian) View
6 Anomaly Detection in Hospital Claims Using K-Means and Linear Regression.pdf
Document Type : [PAK] Full Dokumen
[PAK] Full Dokumen View