From: The effects of class rarity on the evaluation of supervised healthcare fraud detection models
Year | Part B | Part D | DMEPOS | Combined | ||||
---|---|---|---|---|---|---|---|---|
Fraud | %Fraud | Fraud | %Fraud | Fraud | %Fraud | Fraud | %Fraud | |
(a) By year | ||||||||
2012 | 546 | 0.062 | – | – | – | – | – | – |
2013 | 403 | 0.044 | 465 | 0.069 | 323 | 0.110 | 229 | 0.090 |
2014 | 285 | 0.030 | 329 | 0.047 | 193 | 0.068 | 154 | 0.061 |
2015 | 175 | 0.018 | 224 | 0.031 | 119 | 0.041 | 90 | 0.035 |
2016 | 99 | 0.010 | 135 | 0.018 | 75 | 0.026 | 55 | 0.021 |
PCC | Part B | Part D | DMEPOS | Combined | ||||
---|---|---|---|---|---|---|---|---|
Fraud | %Fraud | Fraud | %Fraud | Fraud | %Fraud | Fraud | %Fraud | |
(b) Class imbalance and rarity | ||||||||
All | 1409 | 0.038 | 1018 | 0.048 | 635 | 0.074 | 437 | 0.062 |
1000 | 1000 | 0.027 | – | – | – | – | – | – |
400 | 400 | 0.011 | 400 | 0.019 | 400 | 0.046 | – | – |
200 | 200 | 0.005 | 200 | 0.010 | 200 | 0.023 | 200 | 0.026 |
100 | – | – | 100 | 0.005 | 100 | 0.012 | 100 | 0.013 |