Gartner Research

How to Use Social Network Analysis to Detect Health Insurance Fraud

Published: 25 March 2010

ID: G00175376

Analyst(s): Maureen O'Neil

Summary

The technology of social network analysis provides U.S. health insurers with an approach to identify the human networks and relationships that may undergird fraudulent behavior. CIOs can then enhance their enterprise fraud management strategy based on those insights.

Table Of Contents
  • Overview
  • Introduction
  • New Fraud Schemes Taking Root
  • Social Network Analysis Probes the Linkages Among Potential Fraudsters
  • Take These Five Steps to Develop a Social Network Analysis Plan
    • Identify the Construct That Would Benefit From SNA
    • Prepare the Network Map
    • Determine the Technical Methods for the Analysis Plan, Including Sources of Data, Data Collection Plan and Visualization Criteria to Be Used to Convey the Patterns Found in the Data
    • Decide the Key Metrics That Will Be Applied
    • Conduct the SNA
  • Tactical Guidelines

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