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Fraud detection and explanation in medical claims using GNN architectures

Abstract This paper addresses the critical challenge of fraud detection in medical insurance claims-a pervasive issue causing significant financial losses in healthcare-using Graph Neural Networks (GNNs). Given the intricate nature of healthcare data, traditional fraud detection methods do not inher...

Ausführliche Beschreibung

Gespeichert in:
Hauptverfasser: Reem Muhammad, Dina Tbaishat, Amril Nazir, Seif Yacoub, Mustafa AbdulRazek, Mohamed Ahmed Abo El-Enen, Ahmed T. Sahlol
Format: Artigo
Sprache:Inglês
Veröffentlicht: Nature Portfolio 2025-11-01
Schriftenreihe:Scientific Reports
Schlagworte:
Fraud detection
Medical insurance
Graph neural networks
Heterogeneous graph
GNN explainability
Online-Zugang:https://doi.org/10.1038/s41598-025-22910-6
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