• Prachi Anand Rathi
• Dr. Pankaj Agarkar

Insurance fraud in the healthcare sector is an escalating problem that poses a significant threat to the financial stability of healthcare systems. It encompasses a wide range of deceitful activities, from billing for services not rendered to exaggerating claims and forging prescriptions. The complexity and volume of data involved in healthcare transactions make it challenging to detect fraud using conventional methods. Consequently, there is a pressing need for more sophisticated and adaptive approaches to identify and prevent fraudulent activities effectively. Artificial Intelligence (AI) offers promising solutions to these challenges. AI technologies, including machine learning (ML), deep learning (DL), and natural language processing (NLP), have the potential to revolutionize the detection of healthcare insurance fraud. By analyzing vast datasets and identifying complex patterns and anomalies that may indicate fraudulent behavior, AI can significantly enhance the accuracy and speed of fraud detection processes.

"SECURING HEALTHCARE FINANCES: AI APPROACH TO INSURANCE FRAUD DETECTION", International Journal of Emerging Technologies and Innovative Research (www.jetir.org), ISSN:2349-5162, Vol.12, Issue 4, page no.m314-m319, April-2025, Available :http://www.jetir.org/papers/JETIR2504C41.pdf

"SECURING HEALTHCARE FINANCES: AI APPROACH TO INSURANCE FRAUD DETECTION", International Journal of Emerging Technologies and Innovative Research (www.jetir.org | UGC and issn Approved), ISSN:2349-5162, Vol.12, Issue 4, page no. ppm314-m319, April-2025, Available at : http://www.jetir.org/papers/JETIR2504C41.pdf