From Prediction to Explainable Provider Behavior Profiles for Fraud, Waste, and Abuse Review
Claims data can show that provider behavior changed but cannot by itself explain why. Fraud, waste, and abuse (FWA) review requires identifying material behavior, locating the codes and dollars driving it, and testing plausible explanations. Forecast residuals conflate growth, service-line shifts, code maintenance, and...
Yubin Park, Evan Brociner
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