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International Journal for Research Trends and Innovation
International Peer Reviewed & Refereed Journals, Open Access Journal
ISSN Approved Journal No: 2456-3315 | Impact factor: 8.14 | ESTD Year: 2016
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Issue: May 2026
Volume 11 | Issue 5
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Impact Factor : 8.14
Issue per Year : 12
Volume Published : 11
Issue Published : 120
Article Submitted : 24204
Article Published : 9239
Total Authors : 24597
Total Reviewer : 847
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| Paper Title: | AI-Based Health Insurance Claim Fraud Detection System |
| Authors Name: | Athira S , Kavya Sreekumar , Saravanan |
| Download E-Certificate: | Download |
| Author Reg. ID: |
IJRTI_212237
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| Published Paper Id: | IJRTI2604339 |
| Published In: | Volume 11 Issue 4, April-2026 |
| DOI: | |
| Abstract: | The rapid growth of the healthcare insurance industry has led to an increase in fraudulent claims, resulting in significant financial losses. This paper presents an AI-Based Health Insurance Claim Fraud Detection System developed using Python, Django, and machine learning techniques. The system aims to identify fraudulent claims accurately by analyzing patient details, treatment information, and billing patterns. The fraud detection module utilizes Optical Character Recognition (OCR) to extract text from medical bills and a Logistic Regression model to calculate a fraud probability score. A Smart Audit engine further enhances the system by applying automated business rules, such as policy velocity checks. Results show that the system improves auditing efficiency and reduces manual effort |
| Keywords: | Artificial Intelligence, Machine Learning, Fraud Detection, OCR, Health Insurance, Logistic Regression, Smart Audit. |
| Cite Article: | "AI-Based Health Insurance Claim Fraud Detection System", International Journal for Research Trends and Innovation (www.ijrti.org), ISSN:2456-3315, Vol.11, Issue 4, page no.c558-c563, April-2026, Available :http://www.ijrti.org/papers/IJRTI2604339.pdf |
| Downloads: | 000205507 |
| ISSN: |
2456-3315 | IMPACT FACTOR: 8.14 Calculated By Google Scholar| ESTD YEAR: 2016 An International Scholarly Open Access Journal, Peer-Reviewed, Refereed Journal Impact Factor 8.14 Calculate by Google Scholar and Semantic Scholar | AI-Powered Research Tool, Multidisciplinary, Monthly, Multilanguage Journal Indexing in All Major Database & Metadata, Citation Generator |
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Published Paper ID: IJRTI2604339
Registration ID:212237
Published In: Volume 11 Issue 4, April-2026
DOI (Digital Object Identifier):
Page No: c558-c563 Country: Thiruvananthapuram, Kerala, India Research Area: Engineering Publisher : IJ Publication Published Paper URL : https://www.ijrti.org/viewpaperforall?paper=IJRTI2604339 Published Paper PDF: https://www.ijrti.org/papers/IJRTI2604339 |
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ISSN: 2456-3315
Impact Factor: 8.14 and ISSN APPROVED,
Journal Starting Year (ESTD) : 2016
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