MapReduce-iterative support vector machine classifier: novel fraud detection systems in healthcare insurance industry

International Journal of Electrical and Computer Engineering (IJECE)
Vol. 13, No. 1, February 2023, pp. 756~769
ISSN: 2088-8708, DOI: 10.11591/ijece.v13i1.pp756-769  756
Journal homepage: http://ijece.iaescore.com
MapReduce-iterative support vector machine classifier: novel
fraud detection systems in healthcare insurance industry
Jenita Mary Arockiam, Angelin Claret Seraphim Pushpanathan
Department of Computer Science, College of Science and Humanities, SRM Institute of Science and Technology, Tamil Nadu, India
Article Info ABSTRACT
Article history:
Received Nov 30, 2021
Revised Jul 14, 2022
Accepted Aug 19, 2022
Fraud in healthcare insurance claims is one of the significant research
challenges that affect the growth of the healthcare services. The healthcare
frauds are happening through subscribers, companies and the providers. The
development of a decision support is to automate the claim data from service
provider and to offset the patient’s challenges. In this paper, a novel
hybridized big data and statistical machine learning technique, named
MapReduce based iterative support vector machine (MR-ISVM) that provide
a set of sophisticated steps for the automatic detection of fraudulent claims
in the health insurance databases. The experimental results have proven that
the MR-ISVM classifier outperforms better in classification and detection
than other support vector machine (SVM) kernel classifiers. From the
results, a positive impact seen in declining the computational time on
processing the healthcare insurance claims without compromising the
classification accuracy is achieved. The proposed MR-ISVM classifier
achieves 87.73% accuracy than the linear (75.3%) and radial basis function
(79.98%).
Keywords:
Big data
Fraud detection
Insurance claims
Iterative support vector
machine
MapReduce framework
This is an open access article under the CC BY-SA license.
Corresponding Author:
Angelin Claret Seraphim Pushpanathan
Department of Computer Science, College of Science and Humanities, SRM Institute of Science and
Technology
Kattankulathur, Chennai District, Tamil Nadu 603203, India
Email: angelins@srmist.edu.in
1. INTRODUCTION
The recent advancements made in communication and digital technologies have revolutionized the
modern world. It develops a highly connected environment among the communication entities. Different
types of networks such as social platforms, e-commerce, blogs, industrial trading, banking and insurance
networks are increasing along with the development of communication technologies. A tremendous volume
of data is being generated from these networks. A billion transactions are carried out in a fraction of seconds.
A vast array of information is easily accessible by the fraudsters (or) attackers via creating anonymous
platforms [1]. The growth of anomalous networks, fraudsters have developed several opportunities to
manipulate the data without the user’s knowledge. Many organizations employ preventive measures to secure their
networks and data from internal and external threats with the help of digital technologies. Special considerations
are taken on the interactions and the activities performed among the inter-network entities [2]–[5].
A widespread of machine learning (ML) algorithms is incessantly explored in the different fields of
real-time applications. In recent years, it has been increasing prominence due to the popularity of big data
[6]–[8]. The problems in ML algorithms are known to be the issue of learning from experience by analyzing
some tasks and performance measures. It helps the users to unleash the data structure and develop the

Int J Elec & Comp Eng ISSN: 2088-8708 
MapReduce-iterative support vector machine classifier: novel fraud detection … (Jenita Mary Arockiam)
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predictions model from large datasets. ML proliferates the learning algorithms, rich set of information and
dynamic computing environments.
Figure 1 illustrates the role of ML algorithms in big data. The ML component is surrounded by four
elements: big data, system, user, and domain. The communication flows between all elements are bi-
directional. Large and complex financial data is given as the input to the machine learning components, and
then the extensive data computation becomes a part of big data.
Here, the user provides domain analysis and feedback to the learning element, which eases the
decision-making process. The domain component provides the context guidelines to the learned models. The
System component deals with the infrastructure module that illustrates the usage of computing environments
like distributed computing, and edge computing [9].
The growth of assisting connected devices and communication technologies has developed a
passage for stealers to manipulate the data, leading to a severe financial loss crisis for the healthcare sectors.
Hence, the researchers have explored data security analytics [10]. In the insurance sector, fraud activities
distress both customers as well as insurers. It decreases the trust and loyalty between customers and insurers.
A diversified process and products in healthcare services are being designed with the use of medical
technologies. Healthcare insurance management systems administer the different insurance companies and
the healthcare organizations in the marketplace. Generally, it includes two models, namely, the payment
model and the claim management models. The real challenge pertains to the claim management process,
which allows for more advanced analysis like fraud management [11], [12]. Figure 2 illustrates the scope of
the fraud detection approach during the insurance claim management process.
Figure 1. Role of machine learning (ML) in big data Figure 2. Scope of fraud detection approach
There has been a myriad of studies in detecting fraud claims in the healthcare industry. The review
study has analyzed from two aspects, class imbalance and features representation. Class imbalance and
feature representation are some of the classical problems in machine learning algorithms [13]. Due to the
improper definition of features, an imbalance occurs between the classes, i.e. one class has high data samples
whereas the other class has low data samples. Finding the abnormal claims is a challenging task due to the
issues mentioned earlier.
The performance of ML techniques in financial frauds has been surveyed by [14]. The general
techniques involved in machine learning are descriptive techniques, predictive techniques, artificial
intelligence techniques and hybrid techniques. The analysis has stated that the hybrid techniques, genetic
algorithm and support vector machine (SVM) outperformed better than other techniques [15]–[17]. The
solution to financial frauds is always a never-ending task because of class imbalance. Frauds and abuse are
the two factors that incline healthcare costs. Due to class imbalance, it is highly affected by the Brazilian
Health Care Market [18]. Service Providers were asked to find out the link between fraud and abuse on the
claim authorization process. The execution of cross-validation distribution on treatment methods, machine
learning algorithms like SVM, C4.5, random forest and naive Bayes were analyzed. The results have stated
that the random forest was not affected by the class imbalance. Other ML algorithms were involved when the
class distribution changed.
Insurance frauds have become more complex due to the accumulation of prominent data resolved by
big data predictive modelling [19]. Distributed and the ML algorithms tested parallel computing tools to
differentiate the fraud records. The fraudulent patterns change over time, and thus, an imbalance between the
detected patterns creates trouble for the detection approaches. Concept drift [20] is a domain that

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encompasses the dynamic data, i.e. change over time. Labelling of unsupervised data requires concept
learning. The authors have dealt with automatic labelling of unsupervised data using the concept drift
approach. A permutation test was conducted over each statistical data, and the p-value determined the class
of data. Since it follows a one-fixed algorithm, the effects of class imbalance are high in noisy data.
The decision support tools require an intensive SME analysis when it comes to prepayment and
post-payment control models. The presence of outliers in medical data lowered the accuracy of the detection
framework. Outlier detection techniques [21] were explored to find the misclassified patterns, i.e. false
positive rate. It tested on Medicaid data of 650,000 healthcare claims and 369 dentists of one state. An
improper cluster formation has increased the FPR, and also, the estimated clusters mean improper class
distribution. The comprehensive services provided by healthcare sectors have become more portable by
adopting android technologies [22]. The tracking of claiming benefits requires a timely prediction. Because
of the complex data granularity, it has lowered the accuracy of the framework. Thus, methods such as semi
supervised isomap (SSIsomap) activity clustering, simple local outlier factor (SimLOF) outlier detection, and
the Dempster-Shafer theory-based evidence aggregation are studied on the real-world dataset. The behavior
profile pattern also alters when the data size increases, which strongly induces the estimated frequent itemset.
The provider-consumer model incurs a considerable expense from the healthcare systems. Thus, the
anomaly was detected from the provider and consumer models [23]. Brazilian healthcare records from 2008
to 2015 were collected and evaluated using bipartite graphs and k-nearest neighbors algorithm (k-NN)
algorithms. The bipartite charts were employed to find the relationships between those two models. The
detected similar patterns used to classify into potential providers and anomaly classes using k-NN. The
performance measure cost and effectiveness validate it. Instead of validating the number of hospitals, the
available cities and consumer scores was used for effectiveness estimation. Therefore, representing the
features are essential in graph-based approaches.
Several researchers have explored Medicaid to discover fraud in medical data beyond the transaction
level [24]. The multidimensional data analysis was designed for fraud classifications using sparrow’s
insights. The discovered fraud patterns are also from unsupervised data. The data was classified into six
classes based on the levels of fraudulent data patterns were identified. It was concluded that the inefficiency
of training data had lowered the performance of supervised ML techniques. With the above as a base, an ML
model was designed to detect frauds done by physicians [25]. When it comes to billing procedures, the frauds
may be external (or) internal frauds. Irrespective of the claimer, the physicians were also performing the
misuse of billing procedures, which is challenging. Hence, a multinomial Naïve Bayes algorithm was
designed to resolve multi-class classification by following 5-cross validation. The classification was done by
interchanging the features, like field experts, specialty, and provider types. Relied upon F-score, the fraud
levels on procedures done by physicians were reported. It has built an association among different levels of
physicians when handling the claim data.
Association rule mining is also employed to recognize fraudulent patterns. It is used to constructing
associations/correlations between features. Initially, the transaction data was transformed into a set of
clusters, and then some standard association rules [26] were framed. Based on the lift and confidence value,
the data samples were classified into fraudulent and non-fraudulent claims. The analysis of claim data was
concentrated on the feature extraction phase rather than the classification phase. However, some features are
discarded in terms of big data analytics. The invasion of variant actors and commodities [27] in the
healthcare insurance claims has imposed different challenges to the ML techniques. Therefore, an interactive
framework for unsupervised data analysis was required using pairwise computational models such as
analytical hierarchical processing (AHP) and expectation-maximization (EM). CGM Turkey for private
insurance companies was validated under area under curve (AUC). It has been stated that the independent
analysis of actors and the commodities reduced the time rate for predicting fraud. The fragmented nature of
feature representation has brought significant changes towards the facts finding the process of institutions.
The patient rule induction method (PRIM) [28] was designed to extract the anomalies patterns under
big data context. It was implemented in Center for Medicare Services (CMS) 2014 dataset, which has
improved the feature space. While partitioning the feature space, a depth-analysis on different classes is not
done. Since it performs conditional probability on features, the activities of physicians are not traced.
Heuristics approaches on defining optimal fraud indicators are not possible due to the higher accumulation of
false claims. Fake billing frauds are available more than other frauds, especially in auto/vehicle insurance
claims [29]. Comparison models were designed using random forest, naive Bayes and decision tree under
confusion matrix measure. It was implemented in a synthetic dataset, which concluded that the random forest
has outperformed better than the other two models. Feature modelling has a significant part in designing the
classifiers to reduce false positive and true negative rates. Analyzing camouflage behaviors [30] is a
troublesome task from the classification approaches because it sustains for a short period. Patient cluster
divergence-based healthcare insurance fraudster detection (PCDHIFD) was designed to classify the

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fraudulent caused by camouflage behaviors [30]. With the help of patient admission date features, the
correlation value between the patients, hospitals and the providers were computed from a graph-based dense
peak clustering approach. Then, a divergence cluster value was used to detect the fraud patients. The f-
measure has been improved by 15% than other classification models. Interpreting the medical admission-
oriented features affects the classifiers in the camouflage behaviors analysis. This research study proposes a
novel fraud detection model by hybridizing the strengths of big data and machine learning approaches to
solve the insurance claim classification. It reduces the effects of class imbalance over the voluminous data
that has multi-classes. The insurance claim data is preprocessed using MapReduce framework that scales up
the efficiency of data processing capabilities. The deployment of iterative support vector machine (ISVM)
classifier on processed data helps to classify the fraud providers by executing the pointed iterative conditions.
The proposed MapReduce based iterative support vector machine (MR-ISVM) classifier achieves the
objectives of classification accuracy with the less computational time.
2. METHOD
Class imbalance and feature modelling are mutually dependent on supervised based ML techniques.
Multi-class learning (MCL) is a challenging domain between ML and big data analytics. The research on
MCL has not been suggested more than single-class learning (SCL). MCL is defined as the problem of
associating an instance with more than one class, even for binary labels. Conventional methods do not
support MCL because it reduces the prediction accuracy of the application framework. MCL requires a
systematic approach to handle the medical data effectively and enhances cost-saving and detection efficiency.
Feature selection technique (FST) has to take the categorical, continuous, and high-dimensional data to
innovate the MCL domain. Let us define the problem in vector form. Each instance in the database is
represented as, 𝑎 = {𝑎1 … … 𝑎𝑝} where, p represents the final instance. The data instance is obtained from the
domain, 𝐷 = {𝐴1 … … 𝐴𝑝}. Then, each instance a is associated with the class labels, is denoted as, 𝐿𝑎𝑏𝑒𝑙 𝑙 =
{𝑙1 … … 𝑙𝑞} where q represents the final class value. The class labels are obtained from the domain,
𝐶𝑙𝑎𝑠𝑠𝑑𝑜𝑚𝑎𝑖𝑛(𝐶) = {𝐿1, 𝐿2 … … . . 𝐿𝑄}. Each class label contains a possible set of class variables j, which is
represented as 𝐶𝑗 = (1, 2, . . . 𝐾𝑗).
This research aspires on framing a fraud detection model that detects the mishandling of the
claiming process using machine learning algorithms. Ideally, the proposed method is designed to discover
provider abuse by analyzing the variables used in treatment, disease and claim. The steps of the proposed
process are explained in a detailed manner. Figure 3 presents the block diagram of the proposed research.
The proposed research comprises five phases, and they are explained in brief:
a) Data acquisition: It is the foremost step that portrays the information of datasets.
b) Data preprocessing: It is the second step that portrays the organization of the collected datasets.
c) Feature selection: The third step describes the selection of features used for constructing the training
classifier.
d) Classification: It is the fourth step that presents the workflow of the proposed classifier.
e) Detection: It is the final step that assists the testing data.
Figure 3. Block diagram of the proposed study
2.1. Data acquisition
Dataset is collected from the well-known public repository, known as “Healthcare provider fraud
detection analysis” [31]. Provider fraud is one of the biggest scams prevailing in the healthcare industry. Due
to the mishandling of disease and the treatment details by the physician, the providers increase the medical
costs. The metadata of the dataset is presented in section 3. The collected dataset determines the success rate
of the research objectives.

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2.2. Data preprocessing
This step’s task is to organize the data presented in the datasets efficiently. It is achieved by
eliminating the missing values, duplicate data and also developing efficient data partitioning. The
examination of missing values and duplicate data is described in the next section. The development of the
data partitioning is explored by using a novel MapReduce technique. It is found that multiple claim IDs are
generated with various providers, which is differentiated by the diseases. Owing to this, the MapReduce
technique is employed over the ‘inpatient and outpatient’ tables. Based on the disorders, a new table is
created. As the name suggests, the MapReduce technique consists of viz, mapper, and reducer functions. The
mapper function is expressed as,
𝑀𝑎𝑝𝑝𝑒𝑟: (𝑘1, 𝑣1) → [(𝑘2, 𝑣2)] (1)
The reducer function is expressed as,
𝑅𝑒𝑑𝑢𝑐𝑒𝑟: (𝑘2, |𝑣2|) → [(𝑘3, 𝑣3)] (2)
where, 𝑘1&𝑘2 are the input key and the output key; 𝑣1&𝑣2 are the input value and the output value;
(𝑘3, 𝑣3) are the final output key and the value obtained from the reducer function; and |𝑣2| is the final data
list.
The Figure 4 presents the workflow of the MapReduce technique. It consists of four functions,
namely, splitting, mapping, partitioning and reducing. Both the functions execute parallel on the input
datasets by creating many subsets under different cluster nodes. The intermediate output values of the mapper
function will serve as the input to the reducer functions. Based on the user-defined values of many partitions
(p) and the partitioning function, the MapReduce technique executes the steps: i) a unique processor is
created for the master and the slave nodes; ii) master nodes are responsible for assigning the task to the nodes
in the mapper and reducer jobs; iii) for the user-defined partition values, each partition runs on the mapper
node; iv) the output values, i.e. keys and the intermediate values of a mapper job, are preserved in the local
files of local storage; v) the keys and the intermediate values on the local files are then assigned to the
reducer job; and vi) after completing the reducer job, the reduced output with the final values is stored at the
master node.
Figure 4. Workflow of the MapReduce technique

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2.3. Feature extraction and selection
Feature selection is the third step that deals with the extraction of required features to build an
efficient training classifier. The data table contains a high set of features, and thus, the importance of each
feature is studied to eliminate the irrelevant features. Linear discriminant analysis (LDA) is performed over
the data table. The objective of LDA is to explore the linear combination of features that combines two (or)
more classes of objects. The most desired features are obtained from reducing the dimensionalities before
building the classifier. It is the most suitable model for preserving the multiple classes with reduced
dimensions. The claiming procedure depends on the different aspects of the medical reports of the patients. It
is found that a beneficiary holds multiple claiming strategies for multiple diseases. The amount is claimed
based on the disease code, treatment code and the total amount. Here, three types of variables, viz, claiming
variables, disease variables and treatment variables. In this step, we intend to find out the ‘confidence score’
of the bills given by the provider. The estimated confident score will help verify the attributes taken for
creating, validating and verifying the statements provided by the provider. The confidence score function is
calculated:
𝑍 = 𝛽1𝑥1 + 𝛽2𝑥2 + ⋯ . +𝛽𝑑𝑥𝑑 (3)
𝐶𝑜𝑛𝑓𝑖𝑑𝑒𝑛𝑐𝑒𝑠𝑐𝑜𝑟𝑒
𝛽
=
𝛽𝑇𝜇1−𝛽𝑇𝜇2
𝛽𝑇𝐶𝛽
// score function of a class (4)
𝐶𝑜𝑛𝑓𝑖𝑑𝑒𝑛𝑐𝑒𝑠𝑐𝑜𝑟𝑒
𝛽
=
𝑍1−𝑍2
𝑉𝑎𝑟𝑖𝑎𝑛𝑐𝑒𝑜𝑓𝑍𝑤𝑖𝑡ℎ𝑖𝑛𝑔𝑟𝑜𝑢𝑝𝑠
// score function between the classes (5)
For the given score function, the aim is to estimate the linear coefficients of variables that maximize the
score, which is further given as:
𝛽 = 𝐶−1
(𝜇1 − 𝜇2) // coefficients of the model (6)
𝐶 =
1
𝑛1+𝑛2
(𝑛1𝐶1 + 𝑛1𝐶1) // Pooled covariance matrix (7)
where, 𝛽: coefficients of Linear model, C1 and C2: covariance matrices, and 𝜇1&𝜇2: mean vectors.
The discriminant assessment can be done by computing the Mahalanobis distance between two
groups.
𝑀𝑎ℎ𝑎𝑙𝑎𝑛𝑜𝑏𝑖𝑠𝑑𝑖𝑠𝑡𝑎𝑛𝑐𝑒(∆2) = 𝛽𝑇
(𝜇1 − 𝜇2) (8)
At last, we obtain a new data point that can be classified into C1 (default) and C2 (not-default) by following
the conditional formatting on,
(x − (
𝜇1+𝜇2
2
)) ≥ log
p(C1)
p(C2)
(9)
where, 𝛽𝑇
: coefficients of vector, x: vector of the data,
𝜇1+𝜇2
2
: mean value of vector, and
p(C1)
p(C2)
: probability of
class. Depending on the obtained scores, the relevant features are extracted and selected for the classification
purpose.
2.4. Classification
Iterative support vector machine (ISVM) is employed to ease the classification tasks with minimized
computational efforts. It extracts the provider data via feedback loops in an iterative manner. Initially, a
hyperplane data cube is created by combining source data tables and their principal components. Then, a
general SVM is applied to the hyperplane data cube that generates the classification map. MapReduce
framework is employed to receive the required information from the SVM based classification map. The
output obtained from the applied preprocessing technique is combined with the other hyperplane data cube
for the next iteration process. Likewise, the iterative process continues until achieving the stopping criteria.
The proposed steps of the ISVM are given as:
a) Initially, let us consider a K class of interest, {𝐶𝑝}𝑞=1
𝐾
.
b) Initializing the conditions as, K be the number of classes and k=1 and Ω(0)
= {𝐷𝑎𝑡𝑎𝑡𝑎𝑏𝑙𝑒𝑠} 𝑈 {𝑃𝐶1},
where, 𝑃𝐶1 is the principal component of considered data tables.
c) Deriving the classification map 𝐶𝑙𝑎𝑠𝑠 − 𝑀𝑎𝑝𝑆𝑉𝑀
(0)
for the executed SVM on Ω(0)
.

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d) Based on the generated class-map, the K classification maps are created for jth
iteration. Data (x,y) of data
table under the k-th
classification map is represented as,
𝐵𝑆𝑉𝑀
(𝑗)
(𝑥, 𝑦) = {1|𝑖𝑓𝑑𝑎𝑡𝑎(𝑥, 𝑦)𝜖𝑐𝑙𝑎𝑠𝑠𝑆𝑉𝑀} ; {0|𝑜𝑡ℎ𝑒𝑟𝑤𝑖𝑠𝑒} (10)
e) Then, applying the (preprocessing technique) on the 𝐵𝑆𝑉𝑀
(𝑗)
(𝑥, 𝑦) and then filtered the inputs are
represented as, 𝑝𝑟𝑒𝑝𝑟𝑜𝑐𝑒𝑠𝑠𝑖𝑛𝑔𝑆𝑉𝑀
(𝑗)
(𝑥, 𝑦)
f) Creating the new hyperplane data cube as,
Ω(𝑗)
= Ω(𝑗−1)
𝑈 {𝑝𝑟𝑒𝑝𝑟𝑜𝑐𝑒𝑠𝑠𝑖𝑛𝑔𝑆𝑉𝑀,1
(𝑗)
} 𝑈 {𝑝𝑟𝑒𝑝𝑟𝑜𝑐𝑒𝑠𝑠𝑖𝑛𝑔𝑆𝑉𝑀,𝑛
(𝑗)
}
g) Executing the SVM on Ω(𝑗)
to generate 𝐶𝑙𝑎𝑠𝑠 − 𝑀𝑎𝑝𝑆𝑉𝑀
(𝑗)
h) Stopping rule is defined for terminating the iteration i.e. Feedback process, which is explained in the next
section.
i) If 𝐶𝑙𝑎𝑠𝑠 − 𝑀𝑎𝑝𝑆𝑉𝑀
(𝑗)
, satisfies the stopping rule, then the ISVM is stopped. Atlast, the final classification
map is declared.
j) Else, the process continues by following the step (d), by iteratively, j= j+1.
2.5. Framing of stopping rule for ISVM
The main concept behind the stopping rule of ISVM is to find the best classification maps obtained
from jth
and (j-1)th
iterations. Tanimoto index (TI) is employed to find the best stopping rules from the
generated classification maps. It is given as,
𝑇𝐼(𝑗)
=
|𝑆𝑖𝑧𝑒𝑗 ∩ 𝑠𝑖𝑧𝑒𝑗−1 |
|𝑆𝑖𝑧𝑒𝑗 ∪ 𝑠𝑖𝑧𝑒𝑗−1 |
(11)
where, 𝑆𝑖𝑧𝑒𝑗
; 𝑠𝑖𝑧𝑒𝑗−1
are the classification maps.
TI ranges from [0, 1] and a threshold value 𝛽 is defined. If obtained classification maps cross
higher than the given threshold 𝛽, then the iteration is stopped. Figure 5 represents the functionality of the
ISVM.
Figure 5. Functional block diagram of the ISVM
3. RESULTS AND DISCUSSION
The proposed framework is applied to the real-world insurance provider data obtained from medical
fraud provider detection the previous model is compared with the proposed model using institution-level
variables. From the Medicare data warehouse, beneficiary, inpatient and outpatient data details are preserved
in different tables. The Table 1 presents the tables and their details. It is to be noted that the unique feature
between inpatient and outpatient data is the absence of diagnosis code.

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Table 1. Used database tables and their details
Data Tables Details No. of features
Beneficiary Basic information of the patients i.e. outpatients as well as inpatients details such as Gender,
Claiming details, and Reimbursement details
25
Outpatient It contains details of the patients who visited hospitals but were not admitted. E.g. ClaimID,
ProviderID, and PhysicianID
27
Inpatient It contains details of the patients admitted in the hospital. E.g. ClaimID, ProviderID,
PhysicianID, and Diagnosis code
30
The Table 1 presents the database tables and their feature details. The data is preprocessed using
MapReduce technique that eliminates the medical treatment records, claiming records, removing missing
values, and fixing errors. As a result, we have used 5,000 records for modeling. Provider ID and the
Beneficiary ID are the primary key and the claim details like reimbursement and the deductible amount are
taken as the secondary key value of this study. The collected dataset is preprocessed using MapReduce
framework. A beneficiary can hold the inpatient and outpatient data and thus, it is organized using
MapReduce framework which is given as:
BENE11001 → (Inpatient, 3) & (Outpatient, 0)
BENE11002 → (Inpatient, 0) & (Outpatient, 1)
BENE11014→ (Inpatient, 1) & (Outpatient, 1)
Table 2 presents the sample records organized using the MapReduce framework. The primary key is
to recognize the “clean and organized” data that can reuse the previous results, i.e., it splits the input data into
smaller volumes of data quickly and stably. These smaller data volumes may ensure that more small data
volumes are clean. Regardless, much smaller data volume increases the overhead, and thus, the designed
MapReduce framework, as a preprocessor, must assure stability and speed. In the view of sorting the data
imbalance issue, the MapReduce framework adoption has scrutinized the cardinality of the majority and
minority classes. Compared to the synthetic minority oversampling technique (SMOTE), the proposed
MapReduce technique has modified the intrinsic way of data learning process. The developed Java-based
decision support engine is associated with MySQL using java server pages (JSP) scripts. The feature
extraction process on the preprocessed data involves claims cost validation. A new data table, ‘Unbundled
date’’ is created and linked with the proposed (ISVM) classifier. The claims are split into two, namely:
i) claims with the approved costs within each diagnostic related group and ii) claims with the disapproved
costs within each diagnostic related group.
Table 2. Sample records organized using MapReduce framework
Beneficiary ID Count
BENE11002 1
BENE11003 2
BENE11004 12
BENE11005 8
BENE11006 1
BENE11007 4
BENE11008 1
BENE11009 2
BENE11132 16
BENE11012 15
BENE11016 15
BENE11024 11
BENE11045 11
LDA is used to haul out a nominal attributes subset that aims for the probability distribution of data
classes. The separated classes are close to the original class data distribution by making use of attributes. A
new data table is constructed to the estimated ‘confidence score’ of the bills given by the provider. The
choice of features based on the LDA are, attendance data, hospital code, diagnostic related group, Claim bill,
and drug bill. The dataset is subjected to the ISVM by 70% training and 30% for testing. The approved
claims are then fed into ISVM training classifier. The best data those that meet the confidence score of
LDA’s criteria are classified first. Each instance of this dataset is organized into “Fraud provider” (or) “Legal
Provider”. The proposed iterative conditions fed into the ISVM classifier to detect the fraud providers are:
i) count of total BeneID is compared with the total ClaimID for each provider. If the count of BeneID is
greater than the count of ClaimID, it is labeled as a fraud provider; ii) claimStartDate and ClaimEndDate are

 ISSN: 2088-8708
764
matched with PatientAdmissionDate and DischargeDate; and iii) inpatient claim admit diagnosis code is
matched with the outpatient diagnosis code.
After each classification, the confusion matrix is displayed. The matrix is embossed of the count of
true legal, true fraud, false legal, and false fraud.
a) True legal provider: It includes the count of 'approved costs" correctly classified as "True legal provider"
by the ISVM classifier.
b) True fraud provider: It includes the count of 'disapproved costs' correctly classified as "True fraud
provider" by the ISVM classifier.
c) False legal provider: It includes the count of 'disapproved costs" incorrectly classified as "False legal
provider," even though they are not, by the ISVM classifier.
d) False fraud provider: It includes the count of 'approved costs", which were incorrectly classified as "False
fraud provider," even though they are not by the ISVM classifier.
The Figure 6 presents the proposed implementation framework. The performance metrics are
employed to evaluate the MR-ISVM classifiers.
a) Accuracy: The proportion of recognizing the classes to the proportion of aggregate total data samples.
The efficacy of the accuracy metric is achieved on the balanced datasets which is expressed as,
𝐴𝑐𝑐𝑢𝑟𝑎𝑐𝑦 =
𝑇𝐿𝑃+𝑇𝐹𝑃
𝑇𝐿𝑃+𝑇𝐹𝑃+𝐹𝐿𝑃+𝐹𝐹𝑃
(12)
b) Precision: The proportion of true legal providers and true fraud providers to the classified positive data
samples. It implies the confidence level of the fraud detection, which is expressed as,
𝑃𝑟𝑒𝑐𝑖𝑠𝑖𝑜𝑛 =
𝑇𝐿𝑃
𝑇𝐿𝑃+𝐹𝐿𝑃
(13)
c) Recall: The proportion of true legal providers to the classified positive samples. It implies efficiency of
detection rate, which is expressed as,
𝑅𝑒𝑐𝑎𝑙𝑙 =
𝑇𝐿𝑃
𝑇𝐿𝑃+𝐹𝐹𝑃
(14)
Figure 6. Implementation framework
Table 3 and Figure 7 represents the number of fraud data available in the testing datasets. The
accuracy of the MR-ISVM classifier is evaluated from the classification and detection ability of fraudulent
providers. The proposed MR-ISVM classifier is tested in 10-fold cross validation of hyperparameters (C,𝛽).
A random search is performed on ISVM parameter training until classifying the optimal claims data samples.
The sample screenshots of the proposed framework are shown in Figure 8.

765
Table 3. Fraud provider types based on data volume
Fraud provider types Sample data size
1,000 2,000 3,000 4,000 5,000
Identity-wise analysis 6 8 45 34 22
Date-wise analysis 0 56 34 12 98
Diagnosis code-wise analysis 45 23 35 122 406
Figure 7. Number of fraud data
Figure 8. Sample screenshots

 ISSN: 2088-8708
766
From Table 4 and Figures 9 to 11 represents statistics of the SVM classifiers on sample data size.
The confusion matrix is also known as the error matrix that helps to visualize the performance of the iterative
SVM classifier. As the sample data size increases and given iterative conditions, the classification, and
detection of fraud claims incline exponentially.
Table 4. Summary statistics of SVM classifiers on sample sizes
Kernels used Data size Accuracy (%) Precision (%) Recall (%)
Linear 1000 68.03 56.00 66.90
2000 73.03 79.80 0.001
3000 78.90 86.34 65.00
4000 83.45 78.09 56.12
5000 73.09 81.03 67.98
Radial basis function 1000 72.45 65.45 63.09
2000 70.12 87.34 25.67
3000 81.45 98.33 45.34
4000 89.34 67.89 39.45
5000 86.56 85.00 78.90
Iterative loop 1000 73.45 58.91 89.76
2000 96.78 94.35 98.34
3000 89.56 96.45 87.46
4000 83.56 97.88 40.78
5000 95.34 97.32 83.45
Figure 9. Accuracy analysis
Figure 10. Precision analysis

767
Figure 11. Recall analysis
Table 5 represents the average of different versions of the SVM classifier's performances. It is
observed that the MR-ISVM classifiers perform better classification with an accuracy of 87.73%, followed
by 88.98% precision and 79.95% recall. Compared to the radial basis function and linear kernels, the
MR-ISVM outperformed better to classify and detect the fraud provider.
Figure 12 represent the analysis of the computational time of the MR-ISVM classifier with the linear
and radial basis function. Along with the classification, the required time in computing the sample datasets is
significant in this study. It is understood from the above analysis that the computational time increases
depending on the volume of the sample dataset.
Figure 13 presents the comparative analysis between the existing and proposed techniques. The
proposed MR-ISVM classifier takes less computational time than the linear and radial basis functions. The
variation in instant time is owing to the training dataset using the MapReduce framework. As we know that
the data has been growing widely and rapidly in recent times. Thus, more computational resources need
proper and accurate machine learning approaches.
Table 5. Average performance analysis of SVM classifiers
Kernels used Accuracy (%) Precision (%) Recall (%)
Linear 75.3 76.25 51.2
Radial basis function 79.98 80.8 50.49
Iterative loop 87.73 88.98 79.95
Figure 12. Number computational time analysis

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Figure 13. Comparative techniques with proposed MR-ISVM
4. CONCLUSION
The healthcare industry generates a tremendous amount of data from heterogeneous data sources
like medical reports, hospital devices, and billing systems. The healthcare data transactions are too complex
and voluminous to be computed by conventional methods. Fraud detection is one of the major research areas
that need to be scaled up in real-time scenarios. It is a kind of risk management control activity. Class
imbalance and feature modeling are the major issues that degrade the performance of machine learning
approaches on healthcare data. This research work aims to introduce a novel fraud detection model by
hybridizing the qualities of big data and machine learning approaches. The collected insurance claims data is
preprocessed using the MapReduce framework that categorizes the voluminous claims data. The required
features related to the disease, treatment, and total amount are modeled using LDA. The ISVM approach is
widely explored due to its strength in separating the claims data into legal and fraud providers. The soft
margin function enables the separation of claims data, which is done by iterative conditions. Thus, the fraud
detection systems support the combination of two approaches and achieve higher fraud detection accuracy.
The implementation analysis has demonstrated that the MR-ISVM classifier outperforms better in
classification and detection than other SVM kernel classifiers. The achieved results explore a positive impact
in reducing the computational time on processing healthcare insurance claims without compromising the
classification accuracy. The proposed MR-ISVM classifier achieves 87.73% accuracy than the linear (75.3%)
and radial basis function (79.98%).
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BIOGRAPHIES OF AUTHORS
Jenita Mary Arockiam Currently persuing as a Research Scholar in the
Department of Computer Science, College of Science and Humanities, SRM Institute of Science
and Technology. Received bachelor’s degree from the Computer Science Department, J. A.
College affiliated to MK University, Madurai in 2000. Master of Computer Application degree
from MGR arts-science College, Periyar University, Salem in 2003. M.Phil. degree from Periyar
University, Salem in 2008. Having Twelve years of experience in teaching field and very much
interested in big data analytics especially machine learning. She can be contacted at email:
ja3368@srmist.edu.in.
Angelin Claret Seraphim Pushpanathan Currently working as an Assistant
Professor in the Department of Computer Science at SRM Institute of Science and Technology,
Chennai. Received doctorate degree from Bharathiar University, Coimbatore. Having 15 years of
teaching experience and published many articles related to component-based power distribution
system under various SCI and Scopus indexed journal. Area of research focuses on component-
based technology, power distribution system, internet of things, machine learning, artificial
intelligence with healthcare. She can be contacted at email: angelins@srmist.edu.in.

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