© D.L. Crumbley
Some Data Mining Application
3. Medical/dental applications – Patient substitutions; over-utilizations of specific diagnoses inconsistent with the patient population; excessive number of patients traveling great distances to a provider open seven days a week for disproportionate number of non-emergency procedures (could indicate provider is filing false claims and is spreading out the submissions to divert suspicion).
4. Assistance in due diligence testing – By revealing the business rules, data mining tools can be used to train new auditors and, for new areas or new systems that are being audited for the first time, they are the ideal application to be used for due diligence testing.