Table 1 Description of features chosen from the Medicare datasets
From: The effects of class rarity on the evaluation of supervised healthcare fraud detection models
Datasets | Feature | Description | Type | |
|---|---|---|---|---|
Combined | Part B | npi* | Unique provider identification number | Categorical |
provider_type | Medical provider’s specialty (or practice) | Categorical | ||
nppes_provider_gender | Provider’s gender | Categorical | ||
line_srvc_cnt | Number of procedures/services the provider performed | Numerical | ||
bene_unique_cnt | Number of distinct Medicare beneficiaries receiving the service | Numerical | ||
bene_day_srvc_cnt | Number of distinct Medicare beneficiary / per day services performed | Numerical | ||
average_submitted_chrg_amt | Average of the charges that the provider submitted for the service | Numerical | ||
average_medicare_payment_amt | Average payment made to a provider per claim for the service performed | Numerical | ||
Part D | npi* | Unique provider identification number | Categorical | |
specialty_description | Medical provider’s specialty (or practice) | Categorical | ||
bene_count | Number of distinct Medicare beneficiaries receiving the drug | Numerical | ||
total_claim_count | Number of drug the provider administered | Numerical | ||
total_30_day_fill_count | Number of standardized 30-day fills | Numerical | ||
total_day_supply | Number of day’s supply | Numerical | ||
total_drug_cost | Cost paid for all associated claims | Numerical | ||
DMEPOS | referring_npi* | Unique provider identification number | Categorical | |
referring_provider_type | Medical provider’s specialty (or practice) | Categorical | ||
referring_provider_gender** | Provider’s gender | Categorical | ||
number_of_suppliers | Number of suppliers used by provider | Numerical | ||
number_of_supplier_beneficiaries | Number of beneficiaries associated by the supplier | Numerical | ||
number_of_supplier_claims | Number of claims submitted by a supplier due to an order by a referring order | Numerical | ||
number_of_supplier_services | Number of services/products rendered by a supplier | Numerical | ||
avg_supplier_submitted_charge | Average payment submitted by a supplier | Numerical | ||
avg_supplier_medicare_pmt_amt | Average payment awarded to suppliers | Numerical | ||
All | Exclusion | Fraud labels from the LEIE database | Categorical | |