Sold by: MphasisÂ
Deployed on AWS
An Ensemble Learning based solution to predict potential fraud in Healthcare Claims
Overview
Healthcare fraud occurs due to collusion of providers, physicians and/ or beneficiaries through misuse of medical insurance systems. Manual detection of frauds in healthcare industry is a strenuous task. This solution involves scrutiny and prediction of potential fraudulent claims based on the analysis of patterns to comprehend the entity's future behavior. Through timely actions, insurance companies can use the likelihood of healthcare fraud to prevent or mitigate losses.
Highlights
- Ensemble Machine Learning algorithm-based solution that can assist in the decision-making process by predicting the likelihood of healthcare fraud to prevent or mitigate losses.
- Leveraging Predictive modeling to detect healthcare fraud can reduce the costs of investigation and can ensure timely payouts.
- Mphasis HyperGraf is an omni-channel customer 360 analytics solution. Need customized Deep Learning/NLP solutions? Get in touch!
Details
Sold by
Delivery method
Latest version
Deployed on AWS
Unlock automation with AI agent solutions
Fast-track AI initiatives with agents, tools, and solutions from AWS Partners.
Features and programs
Financing for AWS Marketplace purchases
AWS Marketplace now accepts line of credit payments through the PNC Vendor Finance program. This program is available to select AWS customers in the US, excluding NV, NC, ND, TN, & VT.
Pricing
Pricing is based on actual usage, with charges varying according to how much you consume. Subscriptions have no end date and may be canceled any time.
Additional AWS infrastructure costs may apply. Use the AWS Pricing Calculator to estimate your infrastructure costs.
Dimension | Description | Cost/host/hour |
|---|---|---|
ml.m5.large Inference (Batch) Recommended | Model inference on the ml.m5.large instance type, batch mode | $20.00 |
ml.m5.large Inference (Real-Time) Recommended | Model inference on the ml.m5.large instance type, real-time mode | $10.00 |
ml.m5.large Training Recommended | Algorithm training on the ml.m5.large instance type | $10.00 |
ml.m4.4xlarge Inference (Batch) | Model inference on the ml.m4.4xlarge instance type, batch mode | $20.00 |
ml.m5.4xlarge Inference (Batch) | Model inference on the ml.m5.4xlarge instance type, batch mode | $20.00 |
ml.m4.16xlarge Inference (Batch) | Model inference on the ml.m4.16xlarge instance type, batch mode | $20.00 |
ml.m5.2xlarge Inference (Batch) | Model inference on the ml.m5.2xlarge instance type, batch mode | $20.00 |
ml.p3.16xlarge Inference (Batch) | Model inference on the ml.p3.16xlarge instance type, batch mode | $20.00 |
ml.m4.2xlarge Inference (Batch) | Model inference on the ml.m4.2xlarge instance type, batch mode | $20.00 |
ml.c5.2xlarge Inference (Batch) | Model inference on the ml.c5.2xlarge instance type, batch mode | $20.00 |
Vendor refund policy
Currently we do not support refunds, but you can cancel your subscription to the service at any time.
Legal
Vendor terms and conditions
Upon subscribing to this product, you must acknowledge and agree to the terms and conditions outlined in the vendor's End User License Agreement (EULA)Â .
Content disclaimer
Vendors are responsible for their product descriptions and other product content. AWS does not warrant that vendors' product descriptions or other product content are accurate, complete, reliable, current, or error-free.
Delivery details
Amazon SageMaker algorithm
An Amazon SageMaker algorithm is a machine learning model that requires your training data to make predictions. Use the included training algorithm to generate your unique model artifact. Then deploy the model on Amazon SageMaker for real-time inference or batch processing. Amazon SageMaker is a fully managed platform for building, training, and deploying machine learning models at scale.
Deploy the model on Amazon SageMaker AI using the following options:
Version release notes
This is the Version 1.1 of the algorithm
Additional details
Inputs
- Summary
If you are using real time inferencing, please create the endpoint first and then use the following command to invoke it:
!aws sagemaker-runtime invoke-endpoint \ --endpoint-name 'heathcare-fraud-detection' \ --body fileb://$file_name \ --content-type 'text/csv' \ --region us-east-2 \ "output.csv"
- Input MIME type
- application/zip, text/csv, text/plain, application/json
https://github.com/Mphasis-ML-Marketplace/Healthcare-Fraud-Detection-System/tree/main/Train%20Input
https://github.com/Mphasis-ML-Marketplace/Healthcare-Fraud-Detection-System/tree/main/Train%20Input
Input data descriptions
The following table describes supported input data fields for real-time inference and batch transform.
Field name | Description | Constraints | Required |
|---|---|---|---|
Physician_ID | It contains the id of the Physician who attended the patient | Type: FreeText | Yes |
Surgeon | It contains the id of the surgeon who operated on the patient. | Type: FreeText | Yes |
Alt_Physician_ID | It contains the id of the Physician other than Attending Physician and Surgeon who treated the patient. | Type: FreeText | Yes |
Amt_Deductible | It consists of the amount by the patient. That is equal to Total_claim_amount — Reimbursed_amount. | Type: Integer | Yes |
AnnualAmtReimb_OP | It consists of the maximum reimbursement amount for outpatient visits annually. | Type: Integer | Yes |
AnnualAmtDeductible_OP | It consists of a premium paid by the patient for outpatient visits annually. | Type: Integer | Yes |
ClaimAmtReimbursed | It contains the amount reimbursed for that particular Insurance claim.
| Type: Integer | Yes |
AnnualAmtReimb_IP | It consists of the maximum reimbursement amount for hospitalization annually. | Type: Integer | Yes |
AnnualAmtDeductible_IP | It consists of a premium paid by the patient for hospitalization annually. | Type: Integer | Yes |
ClmAdmitDiagnosisCode | It contains codes of the diagnosis performed by the provider on the patient for that claim. | Type: FreeText | Yes |
Resources
Vendor resources
Support
Vendor support
For any assistance reach out to us at:
AWS infrastructure support
AWS Support is a one-on-one, fast-response support channel that is staffed 24x7x365 with experienced and technical support engineers. The service helps customers of all sizes and technical abilities to successfully utilize the products and features provided by Amazon Web Services.
Similar products
Safeguard Healthcare Systems with Artificial Intelligence
Mactores’ Technology Integration & Optimization for Healthcare solution empowers healthcare and life sciences organizations to modernize and scale their operations through seamless adoption of AI, ML, IoT, and cloud-native technologies.
Tailored for providers, payers, pharmaceutical companies, and biotech firms, the healthcare technology integration and optimization solution focuses on elevating patient outcomes, improving operational efficiency, and accelerating scientific research.
Our cloud based healthcare solutions support blockchain-enabled patient data security, telehealth optimization, and real-time clinical reporting dashboards.
Designed to meet stringent regulatory standards such as HIPAA, FDA, and GDPR, our approach ensures compliant, secure, and interoperable system architectures.
Partner with Mactores to accelerate your digital health initiatives, reduce operational complexity, and deliver smarter, data-driven care.
Ensure compliance, security, and data-driven decision-making in healthcare with Mactores' Data Management & Governance solution. Designed for healthcare providers, payers, pharmaceutical, and biotech firms, our offering helps you streamline HIPAA/FDA compliance, improve data quality, and enable secure, scalable analytics. With automated governance frameworks, AI/ML integration, and cloud-native architectures, you'll unlock the full value of your data to improve patient outcomes, accelerate research, and enhance operational efficiency—while staying audit-ready at all times.
Strategic Analytics Consulting for Healthcare by Mactores helps healthcare organizations unlock the full potential of their data with expert guidance in AI integration, digital transformation, and data strategy.
We work with providers, payers, pharmaceutical, and biotech firms to enhance clinical outcomes, streamline operations, and drive innovation. Our consulting approach combines deep healthcare domain expertise with cutting-edge technologies like AI/ML, cloud data lakes, RPA, and generative AI.
From predictive analytics and fraud detection to clinical trial optimization and digital reporting systems, we help healthcare leaders make informed, data-driven decisions.
Partner with Mactores to accelerate your digital transformation journey, future-proof your technology ecosystem, and deliver better care outcomes through intelligent analytics and scalable innovation.
Customer reviews
No customer reviews yet
Be the first to review this product . We've partnered with PeerSpot to gather customer feedback. You can share your experience by writing or recording a review, or scheduling a call with a PeerSpot analyst.