AI-Driven Medical Fundraising Verification System to Detect and Prevent Fraudulent Treatment Requests

Authors- A .Nithish kumar, Assistant Professor Dr.S.Nagasundaram

Abstract-Medical fund fraud continues to be a major challenge in the healthcare industry, causing substantial financial losses and undermining trust in insurance systems. In this work, we introduce an AI-based solution aimed at detecting and preventing fraudulent medical claims. By applying machine learning algorithms such as Decision Trees, Random Forests, and Naive Bayes, the system is able to recognize suspicious patterns and anomalies within claim data. We trained and tested our models on a structured dataset to evaluate their accuracy and performance. The results show that AI techniques can play a powerful role in improving fraud detection, helping healthcare providers and insurers make more informed decisions. This study highlights the value of integrating intelligent technologies into healthcare systems to promote fairness, transparency, and better resource management.

DOI: /10.61463/ijset.vol.13.issue3.102