Abbas Raad; Reza Ofoghi; Ghadir Mahdavi
Abstract
This study aims to examine the function of blockchain technology to detect fraud in health insurance. we consider the literature on fraud in health insurance, blockchain, and smart contracts to to test a newly structured software system based on blockchain technology for this purpose. Different blockchain ...
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This study aims to examine the function of blockchain technology to detect fraud in health insurance. we consider the literature on fraud in health insurance, blockchain, and smart contracts to to test a newly structured software system based on blockchain technology for this purpose. Different blockchain platforms, consensus algorithms, and structures have been used to pick the proposed system’s best structure based on blockchain. Eventually, the best techniques to put the system to the test and evaluate the findings were assessed. we propose a standardized system, where blockchain is applied to store data and smart contracts are used to automate insurance policies. Furthermore, a web-based application, which acts as core insurance software, is proposed for all stakeholders to communicate with the blockchain and smart contracts. Therefore, the proposed system comprises a blockchain, web app, and standardized smart contracts. The proposed system mainly focuses on fraud detection in insurance claims while maintaining a standard data storage and transfer structure. The system proved to be thriving once claim data can be created, read, and analyzed (i.e. fraudulent data are caught) effectively in a standard way. The web app consists of a front-end and back-end section. The front-end enables users to interact with the proposed system, and the back-end allows the insurance company to store records on the blockchain and increase the chances of detecting fraud in insurance claims, especially Digital Insurance Claims. Finally, a blockchain-based web application that can be used as core insurance software for any health insurance company is proposed.
