CN106959954A - A kind of System and method for for being used to detect that entry is submitted an expense account in abnormality medical insurance - Google Patents
A kind of System and method for for being used to detect that entry is submitted an expense account in abnormality medical insurance Download PDFInfo
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- CN106959954A CN106959954A CN201610014639.4A CN201610014639A CN106959954A CN 106959954 A CN106959954 A CN 106959954A CN 201610014639 A CN201610014639 A CN 201610014639A CN 106959954 A CN106959954 A CN 106959954A
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- G06F16/20—Information retrieval; Database structures therefor; File system structures therefor of structured data, e.g. relational data
- G06F16/24—Querying
- G06F16/248—Presentation of query results
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- G06—COMPUTING; CALCULATING OR COUNTING
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- G06F16/2425—Iterative querying; Query formulation based on the results of a preceding query
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Abstract
The invention discloses a kind of system for being used to detect that entry is submitted an expense account in abnormality medical insurance, including the numeric value analysis being sequentially connected and interactive unit, distributed storage unit, digitization tag unit；Numeric value analysis is connected the macroscopical display unit of data and user interface 1 with interactive unit；Distributed storage unit is sequentially connected data retrieval and administrative unit, detection unit, result reporting unit；Detection unit is sequentially connected data model unit and user interface 2；Digitization tag unit connects user interface 3.The present invention discloses a kind of method for being used to detect that entry is submitted an expense account in abnormality medical insurance.The present invention integrates a variety of detection methods, and abnormal medical insurance entry and monitoring medical insurance operation conditions is detected in real time, helps medical insurance administrative staff and medical insurance auditor to improve its operating efficiency and management precision.
Description
Technical field
The present invention relates to medical security and data analysis field, it is used to detect that abnormality medical insurance is submitted an expense account more particularly, to one kind
The System and method for of entry.
Background technology
The huge total amount of medical insurance fund and its important social property, and the medical insurance monetary losses caused are cheated by medical insurance
Seriousness promote relevant governmental in worldwide, enterprise and scholar put into the technology for developing anti-medical insurance fraud,
To develop the anti-medical insurance fraud automation tools of intelligent and high-efficiency, existing method, which is mainly, applies data mining, machine
The information technologies such as study.Publication No. " is used to detect medical guarantor for CN102013084 Chinese invention patent disclosed in 2011
The system and method for dangerous outpatient service fraudulent transactions " propose the detecting system framework and key module of a kind of abnormal medical insurance.
Chinese invention patent " the number of Proportion of Medical Insurance Charges in violation of rules and regulations with fraud that publication No. disclosed in 2013 is CN102945235
According to digging system " propose to be different from detection of the cloth number for the abnormal medical insurance of an other class of CN102013084 Chinese invention patent
System architecture and key module.System of the above-mentioned two on the patent of invention abnormal medical insurance detection model that has been general design
Framework and functional module substantially and module connect relation, do not submit an expense account abnormality medical insurance the specific detection of entry
Method is illustrated.
The content of the invention
The purpose of the present invention is exactly to provide a kind of low cost, general-purpose capability by force, well to overcome above-mentioned existing issue
Autgmentability be used for detect abnormality medical insurance submit an expense account entry System and method for.
To achieve the above object, the present invention provides a kind of system for being used to detect that entry is submitted an expense account in abnormality medical insurance, its feature
It is：Including the numeric value analysis and interactive unit, distributed storage unit, digitization tag unit being sequentially connected；Numeric value analysis
The macroscopical display unit of data and user interface 1 are connected with interactive unit；Distributed storage unit is sequentially connected data retrieval and pipe
Manage unit, detection unit, result reporting unit；Detection unit is sequentially connected data model unit and user interface 2；Digitization mark
Member of signing a bill connection user interface 3.
Described detection unit includes and the classification and Detection module based on demographic characteristics such as patient age, disease, sexes
The expense abnormality detection module of interconnection, medical treatment frequency detection module, diagnosis and treatment specification detection module, comprehensive detection module；It is comprehensive
Detection module is closed simultaneously by expense abnormality detection module, medical treatment frequency detection module, three module structures of diagnosis and treatment specification detection module
Into detection is more comprehensive；Rule base is connected with each other with diagnosis and treatment specification detection module, and rule support is provided for it；Medical treatment frequency is examined
Module, diagnosis and treatment detection module is surveyed to be connected with each other with comprehensive detection module respectively.
A kind of method for being used to detect that entry is submitted an expense account in abnormality medical insurance, it is characterised in that：Comprise the following steps：
301st, user submits the instruction inquired about and shown by user interface 3 to system；
302nd, system obtains pending medical insurance data by interactive interface 1 from medical insurance examining department system；
303rd, numeric label unit by the data of acquisition carry out labeling, quantize, format after according to distributed storage list
The index information of member is stored into default database；
304th, the macroscopical display unit of data sends user instruction to data parsing and interactive unit, and parsing and interactive unit are from distribution
After data needed for being extracted in formula memory cell, the macroscopical display unit of data is sent data to；
305th, the macroscopical display unit of data is carried out after image conversion to data, is shown by interface 3 to user；
306th, storage is directed into detection unit to the data of distributed storage unit by data retrieval and administrative unit, and is turned
It is changed to the form specified；
307th, detection unit judges whether there is default inspection in data model unit is stored according to user by user interface 2
Model is surveyed to detect data；If "Yes", data are detected according to the detection model of user preset；If
"No", then detect according to the detection model of acquiescence to data；
308th, after the data result that detection is completed is standardized by data parsing with interactive unit, distributed storage unit is arrived in storage
In, while being also sent to result reporting unit, detailed testing result is supplied to user.
Described user interface 1 provides the transmission channel of external data, in the system that data to be detected are imported；It is described
User interface 2 makes user's preference pattern from data model unit carry out model specification and parameter selection；The user interface 3 is used
Interacted in user with system, show its desired content.
Compared with prior art, the present invention integrates a variety of detection methods, detect in real time abnormal medical insurance entry and
Medical insurance operation conditions is monitored, helps medical insurance administrative staff and medical insurance auditor to improve its operating efficiency and management precision.
Brief description of the drawings
Fig. 1 is system structure diagram of the invention；
Fig. 2 is detection unit structural representation of the invention；
Fig. 3 is flow chart of the invention.
Embodiment
The present invention is described in detail with specific embodiment below in conjunction with the accompanying drawings.
As shown in figure 1, a kind of system for being used to detect that entry is submitted an expense account in abnormality medical insurance, it is characterised in that：Including connecting successively
The numeric value analysis connect and interactive unit, distributed storage unit, digitization tag unit；Numeric value analysis is connected number with interactive unit
According to macroscopical display unit and user interface 1；Distributed storage unit be sequentially connected data retrieval and administrative unit, detection unit,
As a result reporting unit；Detection unit is sequentially connected data model unit and user interface 2；Digitization tag unit connection user connect
Mouth 3.
As shown in Fig. 2 described detection unit includes and point based on demographic characteristics such as patient age, disease, sexes
The expense abnormality detection module of class detection module interconnection, medical treatment frequency detection module, diagnosis and treatment specification detection module, comprehensive inspection
Survey module；Comprehensive detection module is simultaneously by expense abnormality detection module, medical treatment frequency detection module, diagnosis and treatment specification detection module three
Individual module composition, is detected more comprehensive；Rule base is connected with each other with diagnosis and treatment specification detection module, and rule support is provided for it；Just
Frequency detection module, diagnosis and treatment detection module is cured to be connected with each other with comprehensive detection module respectively.
A kind of method for being used to detect that entry is submitted an expense account in abnormality medical insurance, it is characterised in that：Comprise the following steps：
301st, user submits the instruction inquired about and shown by user interface 3 to system；
302nd, system obtains pending medical insurance data by interactive interface 1 from medical insurance examining department system；
303rd, numeric label unit by the data of acquisition carry out labeling, quantize, format after according to distributed storage list
The index information of member is stored into default database；
304th, the macroscopical display unit of data sends user instruction to data parsing and interactive unit, and parsing and interactive unit are from distribution
After data needed for being extracted in formula memory cell, the macroscopical display unit of data is sent data to；
305th, the macroscopical display unit of data is carried out after image conversion to data, is shown by interface 3 to user；
306th, storage is directed into detection unit to the data of distributed storage unit by data retrieval and administrative unit, and is turned
It is changed to the form specified；
307th, detection unit judges whether there is default inspection in data model unit is stored according to user by user interface 2
Model is surveyed to detect data；If "Yes", data are detected according to the detection model of user preset；If
"No", then detect according to the detection model of acquiescence to data；
308th, after the data result that detection is completed is standardized by data parsing with interactive unit, distributed storage unit is arrived in storage
In, while being also sent to result reporting unit, detailed testing result is supplied to user.
Described user interface 1 provides the transmission channel of external data, in the system that data to be detected are imported；It is described
User interface 2 makes user's preference pattern from data model unit carry out model specification and parameter selection；The user interface 3 is used
Interacted in user with system, show its desired content.
Certainly, described above is not limitation of the present invention, and the present invention is also not limited to the example above, this technology neck
Change, remodeling, addition or replacement that the those of ordinary skill in domain makes in the essential scope of the present invention, should also belong to the present invention
Protection domain.
Claims (4)
1. a kind of system for being used to detect that entry is submitted an expense account in abnormality medical insurance, it is characterised in that：Including the numeric value analysis being sequentially connected
With interactive unit, distributed storage unit, digitization tag unit；It is single that numeric value analysis is connected data macroscopic view display with interactive unit
Member and user interface 1；Distributed storage unit is sequentially connected data retrieval and administrative unit, detection unit, result reporting unit；
Detection unit is sequentially connected data model unit and user interface 2；Digitization tag unit connects user interface 3.
2. the system as claimed in claim 1 for being used to detect that entry is submitted an expense account in abnormality medical insurance, it is characterised in that：Described detection
The expense that unit includes being connected with each other with the classification and Detection module based on demographic characteristics such as patient age, disease, sexes is abnormal
Detection module, medical treatment frequency detection module, diagnosis and treatment specification detection module, comprehensive detection module；Comprehensive detection module is simultaneously by taking
With abnormality detection module, medical treatment frequency detection module, three module compositions of diagnosis and treatment specification detection module, detect more comprehensive；Rule
Then storehouse is connected with each other with diagnosis and treatment specification detection module, and rule support is provided for it；Medical treatment frequency detection module, diagnosis and treatment detection module
It is connected with each other respectively with comprehensive detection module.
3. a kind of method for being used to detect that entry is submitted an expense account in abnormality medical insurance, it is characterised in that comprise the following steps：
301st, user submits the instruction inquired about and shown by user interface 3 to system；
302nd, system obtains pending medical insurance data by interactive interface 1 from medical insurance examining department system；
303rd, numeric label unit by the data of acquisition carry out labeling, quantize, format after according to distributed storage list
The index information of member is stored into default database；
304th, the macroscopical display unit of data sends user instruction to data parsing and interactive unit, and parsing and interactive unit are from distribution
After data needed for being extracted in formula memory cell, the macroscopical display unit of data is sent data to；
305th, the macroscopical display unit of data is carried out after image conversion to data, is shown by interface 3 to user；
306th, storage is directed into detection unit to the data of distributed storage unit by data retrieval and administrative unit, and is turned
It is changed to the form specified；
307th, detection unit judges whether there is default inspection in data model unit is stored according to user by user interface 2
Model is surveyed to detect data；If "Yes", data are detected according to the detection model of user preset；If
"No", then detect according to the detection model of acquiescence to data；
308th, after the data result that detection is completed is standardized by data parsing with interactive unit, distributed storage unit is arrived in storage
In, while being also sent to result reporting unit, detailed testing result is supplied to user.
4. the method as claimed in claim 3 for being used to detect that entry is submitted an expense account in abnormality medical insurance, it is characterised in that：Described user
Interface 1 provides the transmission channel of external data, in the system that data to be detected are imported；The user interface 2 make user from
Preference pattern carries out model specification and parameter selection in data model unit；The user interface 3 is used for user to be carried out with system
Interaction, shows its desired content.
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201610014639.4A CN106959954A (en) | 2016-01-11 | 2016-01-11 | A kind of System and method for for being used to detect that entry is submitted an expense account in abnormality medical insurance |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201610014639.4A CN106959954A (en) | 2016-01-11 | 2016-01-11 | A kind of System and method for for being used to detect that entry is submitted an expense account in abnormality medical insurance |
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| Publication Number | Publication Date |
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| CN106959954A true CN106959954A (en) | 2017-07-18 |
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| Application Number | Title | Priority Date | Filing Date |
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| CN201610014639.4A Pending CN106959954A (en) | 2016-01-11 | 2016-01-11 | A kind of System and method for for being used to detect that entry is submitted an expense account in abnormality medical insurance |
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Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN109669935A (en) * | 2018-12-13 | 2019-04-23 | 平安医疗健康管理股份有限公司 | Check data screening method, apparatus, equipment and storage medium |
| CN111127207A (en) * | 2019-12-28 | 2020-05-08 | 哈尔滨工业大学 | Block chain-based drug sales fraud supervision system and supervision method thereof |
Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN102013084A (en) * | 2010-12-14 | 2011-04-13 | 江苏大学 | System and method for detecting fraudulent transactions in medical insurance outpatient services |
| CN102945235A (en) * | 2011-08-16 | 2013-02-27 | 句容今太科技园有限公司 | Data mining system facing medical insurance violation and fraud behaviors |
| CN104408547A (en) * | 2014-10-30 | 2015-03-11 | 浙江网新恒天软件有限公司 | Data-mining-based detection method for medical insurance fraud behavior |
| CN105159948A (en) * | 2015-08-12 | 2015-12-16 | 成都数联易康科技有限公司 | Medical insurance fraud detection method based on multiple features |
-
2016
- 2016-01-11 CN CN201610014639.4A patent/CN106959954A/en active Pending
Patent Citations (4)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN102013084A (en) * | 2010-12-14 | 2011-04-13 | 江苏大学 | System and method for detecting fraudulent transactions in medical insurance outpatient services |
| CN102945235A (en) * | 2011-08-16 | 2013-02-27 | 句容今太科技园有限公司 | Data mining system facing medical insurance violation and fraud behaviors |
| CN104408547A (en) * | 2014-10-30 | 2015-03-11 | 浙江网新恒天软件有限公司 | Data-mining-based detection method for medical insurance fraud behavior |
| CN105159948A (en) * | 2015-08-12 | 2015-12-16 | 成都数联易康科技有限公司 | Medical insurance fraud detection method based on multiple features |
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN109669935A (en) * | 2018-12-13 | 2019-04-23 | 平安医疗健康管理股份有限公司 | Check data screening method, apparatus, equipment and storage medium |
| CN111127207A (en) * | 2019-12-28 | 2020-05-08 | 哈尔滨工业大学 | Block chain-based drug sales fraud supervision system and supervision method thereof |
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Application publication date: 20170718 |