Smart Assistance to healthcare practitioners in fraud prevention
Summary of the entity:
List institute, a digital systems’ expert. Based in Saclay (Paris region, France), List Institute is one of CEA Tech three technological research institutes constituting CEA technological Division. Dedicated to smart digital systems, our mission is to achieve technological development of excellence for our industrial partners and create value, with more than 200 industrial collaborations per year. List institute counts more than 750 partners and every year more than a 200 partnership activities are being conducted with French and foreign industrial companies on applied research projects in four main topics: Advanced Manufacturing, Embedded systems, Data intelligence and Health ionizing radiations
Summary of the challenge:
The goal is to avoid abuse from patients and customers and minimize the risk of fraud.
Stakeholder: Healthcare professionals
To avoid abuse from patients and customers and minimize the risk of fraud. As it is also the interest of healthcare professionals to promptly detect fraud, it is desirable a trustable collaboration where they can share data regarding patients’ access to healthcare services and products.
For example, in the case of fraud detection of duplicate reimbursement requests, the four most important factors are whether the patient has changed clinicians between visits, what the diagnosis is at the third outpatient visit, what the interval between second and third outpatient visits is, and what the interval between the first and second in patient visits is.
Healthcare professionals are nonetheless also concerned in sharing this data in a lawful manner, which respects the rights and freedoms of patients. Strict compliance with personal data protection regulations such as GDPR is thus essential, as well as the means to prove in a straightforward manner this compliance.
- REACH Data Providers
- Open source datasets:
- To allow healthcare professionals to better collaborate with their patients’ insurance companies, while preserving confidentiality and law compliance with respect to the shared data.
- To provide better value chain collaboration of healthcare practitioners with the insurance sector