AI- Empowered Healthcare Insurance Fraud Detection Using Blockchain

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AI- Empowered Healthcare Insurance Fraud Detection Using Blockchain

Gaurav Kumar Singh1 , Himanshu Kumar2, Jafarullah Ansari3 , Mrs.M.Priyanga4 ,Dr. M.Chandran5 , Dr. G.Victo Sudha George6,

1,2,3 UG Student, Department of Computer Science and Engineering,

Dr. MGR Educational and Research Institute, Maduravoyal, Chennai 600095, TN, India

4,5,6 Professor, Department of Computer Science and Engineering

Dr. MGR Educational and Research Institute, Maduravoyal, Chennai 600095, TN, India

krgauravcse@gmail.com

Abstract: The healthcare industry faces significant challenges due to insurance fraud, which increases costs and undermines trust. Traditional methods of fraud detection are largely manual and unable to keep pace with the complexity and volume of healthcare data. This paper proposes a hybrid system that combines Artificial Intelligence (AI) and Blockchain to address these issues, aiming for a secure, accurate, and transparent approach to healthcare insurance fraud detection. AI analyzes claims data in real-time to detect anomalous patterns, while Blockchain technology ensures secure, immutable records of claims. This paper discusses the architecture, components, and advantages of integrating AI and Blockchain for fraud detection, and highlights the potential of this hybrid approach to transform fraud management in healthcare.

Keywords: Healthcare Insurance, Fraud Detection, Artificial Intelligence, Blockchain, Machine Learning, Transparency, Decentralization.

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