Retraction: Association analysis between pharmacies and pharmaceutical companies in Healthcare Insurance systems

Year 2019, Volume: 2 Issue: 1, 35 - 47, 30.03.2019

Erdi Akpınar Mustafa Cem Kasapbaşı

Abstract

With increasing personal health care costs, governments are working hard on individual health insurance. In this context, insurance systems are improved to cover especially expensive drugs. As the scope of the drug increases, the expenditures in
the system increase accordingly. Malicious people take advantage of the health care
system and cause incidents that exploit the system financially. Detecting such frauds
attempts requires serious work and time. In this study, after the drugs were categorized, the possible anomalies paired with pharmacy and pharmaceutical companies,
which are more than normal sales of drugs of similar category, were determined by
statistical methods. Drug manufacturers can deal with pharmacies and aim to sell
their own medication, which is a counterpart to a drug specified in the doctor’s prescription. In this study, the relationship between the two different entities by normalizing the data has been tried to be correlated with the statistical approach. With the
results obtained, statistical analysis was made and the pharmaceutical manufacturers which are prone to fraud were further narrowed. As a result, it was ensured that
the data pool, which required fraud detection, was narrowed and this determination
was facilitated.

This article was retracted on March 26, 2021.

Keywords

Heath Insurance Fraud, Fraud anomaly detection, Data mining, Normalization

Geri Çekildi: SAĞLIK SİGORTACILIĞINDA ECZANE – İLAÇ ÜRETİCİ FİRMASI ARASINDA İLİŞKİLENDİRME ANALİZİ

Abstract

Artan kişisel sağlık giderleri ile birlikte devletler bireysel sağlık sigortaları üzerinde
ciddi çalışmalar yapmaktadır. Bu kapsamda sigorta sistemleri özellikle pahalı ilaçları kapsayacak şekilde iyileştirilmektedir. İlaç kapsamı arttıkça sistem içerisindeki
harcamalar da buna paralel olarak artmaktadır. Sistemdeki bu durumu gören kötü niyetli kişiler Tıbbi Dolandırıcılık adı verilen ve sistemi büyük maddi zararlara uğratacak girişimlerde bulunmaktadır. Yapılan sahtekârlıkları tespit etmek ciddi çalışma ve
zaman gerektirmektedir. Bu çalışmada, ilaçlar sımıflandırılarak benzer kategorideki
ilaçların normalden fazla satışı olan eczane ve ilaç firmaları eşleştirilmiş muhtemel
anomaliler istatistiksel yöntemlerle tespit edilmiştir. İlaç üretici firmalar ve eczaneler aralarında anlaşma yaparak doktor reçetesinde belirtilen bir ilacın muadili olan
kendisine ait ilacı satmayı hedefleyebilmektedirler. Bu çalışmada, verilerin ölçeklenerek iki farklı varlık arasındaki ilişki istatiksel yaklaşımla değerlendirmeye çalışılmıştır. Elde edilen sonuçlarla istatistiksel analizi yapılarak dolandırıcılığa meyilli
ilaç üretici firmaları daha da daraltılmıştır. Sonuç olarak dolandırıcılık tespiti yapılması gereken veri havuzunun daraltılarak bu tespitin kolaylaştırılması sağlanmıştır. 

Bu makale 26 Mart 2021 tarihinde geri çekildi. 

Keywords

Kümeleme analizi, Sağlık sigortacılığı sahtekarlığı, Sahtekarlık anomaly tespiti, Veri Madenciliği, Normalizasyon

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