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This paper presents a novel approach to detecting hospital billing fraud by combining process mining with semantic analysis. Traditional methods often fail to catch subtle irregularities in complex healthcare processes. Our framework uses process mining to identify patterns and anomalies, while semantic analysis improves accuracy by contextualizing billing activities and uncovering relationships among process elements. Validation on real-world hospital data demonstrates the approach’s effectiveness in identifying fraud, promoting financial integrity and better resource management in healthcare.

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Fraud Detection in Hospital Billing Using Semantic Analysis and Process Mining

  • 会议论文

  • 发表日期：

    2026年

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  • Naoual Smaili,
  • Zineb Lamghari

摘要

This paper presents a novel approach to detecting hospital billing fraud by combining process mining with semantic analysis. Traditional methods often fail to catch subtle irregularities in complex healthcare processes. Our framework uses process mining to identify patterns and anomalies, while semantic analysis improves accuracy by contextualizing billing activities and uncovering relationships among process elements. Validation on real-world hospital data demonstrates the approach’s effectiveness in identifying fraud, promoting financial integrity and better resource management in healthcare.