The Impact Of Data Mining On The Healthcare Industry

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Data mining is used in various forms by different agencies. Detecting fraud and abuse is one of the benefits of the use of data mining. The healthcare industry is big and one of the biggest payers is CMS. However, detecting fraud and abuse in healthcare claims is crucial because billions of money is being wasted in unnecessary care. Data mining is defined as the process of data selection and studying and building models using massive data stores to disclose previously unidentified patterns in databases (Koh and Tan, 2005, p. 64). Koh and Tan have found financial institutions, marketers, manufactures and so has many other agencies have used data mining. Data mining has been of great use by various organizations. For example, data mining has been useful to detect fraudulent credit card transactions (Koh and Tan, 2005, p. 64). Koh and Tan stated, “In healthcare, data mining is becoming increasingly popular, if not increasingly essential” (Koh and Tan, 2005, p.64). In healthcare there have been reports that data mining has been successful in detecting fraud and abuse in healthcare claim (Koh and Tan, 2005, p.65). There are many factors in healthcare that have driven the use of data mining applications. One of the factors that have driven healthcare to use the data mining applications will be the medical insurance fraud and abuse. All organizations currently involved in the healthcare industry can profit from the data mining applications. For example, data mining is able to help
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