Operation of machine learning-based fraud detection and prediction system

The National Health Insurance Service (NHIS) of the Republic of Korea employs proactive data analysis to identify and manage fraudulent activities, particularly focusing on long-term care benefits and health insurance eligibility. In 2023, NHIS enhanced its fraud detection system (FDS) to combat evolving forms of fraud, uncovering 18.534 billion South Korean wons (KRW) in unjust enrichment through machine learning-based detection and prediction systems. By transitioning from experiential to data-driven management, NHIS significantly curbed financial leakage in long-term care financing.