Data Sampling Approaches with Severely Imbalanced Big Data for Medicare Fraud Detection

Author(s):  
Richard A Bauder ◽  
Taghi M Khoshgoftaar ◽  
Tawfiq Hasanin
2019 ◽  
Vol 34 (3) ◽  
pp. 324-337 ◽  
Author(s):  
Jiali Tang ◽  
Khondkar E. Karim

PurposeThis paper aims to discuss the application of Big Data analytics to the brainstorming session in the current auditing standards.Design/methodology/approachThe authors review the literature related to fraud, brainstorming sessions and Big Data, and propose a model that auditors can follow during the brainstorming sessions by applying Big Data analytics at different steps.FindingsThe existing audit practice aimed at identifying the fraud risk factors needs enhancement, due to the inefficient use of unstructured data. The brainstorming session provides a useful setting for such concern as it draws on collective wisdom and encourages idea generation. The integration of Big Data analytics into brainstorming can broaden the information size, strengthen the results from analytical procedures and facilitate auditors’ communication. In the model proposed, an audit team can use Big Data tools at every step of the brainstorming process, including initial data collection, data integration, fraud indicator identification, group meetings, conclusions and documentation.Originality/valueThe proposed model can both address the current issues contained in brainstorming (e.g. low-quality discussions and production blocking) and improve the overall effectiveness of fraud detection.


Author(s):  
D. Gutiérrez-Avilés ◽  
J. A. Fábregas ◽  
J. Tejedor ◽  
F. Martínez-Álvarez ◽  
A. Troncoso ◽  
...  

Web Services ◽  
2019 ◽  
pp. 618-638
Author(s):  
Goran Klepac ◽  
Kristi L. Berg

This chapter proposes a new analytical approach that consolidates the traditional analytical approach for solving problems such as churn detection, fraud detection, building predictive models, segmentation modeling with data sources, and analytical techniques from the big data area. Presented are solutions offering a structured approach for the integration of different concepts into one, which helps analysts as well as managers to use potentials from different areas in a systematic way. By using this concept, companies have the opportunity to introduce big data potential in everyday data mining projects. As is visible from the chapter, neglecting big data potentials results often with incomplete analytical results, which imply incomplete information for business decisions and can imply bad business decisions. The chapter also provides suggestions on how to recognize useful data sources from the big data area and how to analyze them along with traditional data sources for achieving more qualitative information for business decisions.


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