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For the detection of health care insurance fraud, the fraud scenarios were based on the study by Ismail and Zeadally [22], which proposes a taxonomy of 12 fraud scenarios that are divided into 7 categories, as shown in Figure 1. The first category is commission-based, which includes 3 fraud scenarios. The first scenario involves a health care provider directing patients to specific hospitals, clinics, pharmacies, medications, or equipment suppliers in return for a commission.
J Med Internet Res 2024;26:e50730
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