Paper Contents
Abstract
This paper reviews HealthGuard AI, an innovative healthcare insurance fraud detection system developed as a Master of Computer Applications (MCA) final year project. The system combines rule-based analysis with artificial intelligence, specifically leveraging Groq AI for pattern recognition to identify potentially fraudulent insurance claims in real-time. This review evaluates the system's architecture, methodology, performance metrics, and potential applications in the healthcare industry. The significance of this project lies in its approach to combating healthcare insurance fraud, which costs the industry billions of dollars annually and leads to higher premiums and reduced coverage for legitimate patients.
Copyright
Copyright © 2025 Ayush Rajendra Fulzele. This is an open access article distributed under the Creative Commons Attribution License.
