Association analysis between pharmacies and pharmaceutical companies in Healthcare Insurance systems

With increasing personal health care costs, governments are working hard on individual health insurance. In this context, insurance systems are improved to cover especially expensive drugs. As the scope of the drug increases, the expenditures in the system increase accordingly. Malicious people take advantage of the health care system and cause incidents that exploit the system financially. Detecting such frauds attempts requires serious work and time. In this study, after the drugs were categorized, the possible anomalies paired with pharmacy and pharmaceutical companies, which are more than normal sales of drugs of similar category, were determined by statistical methods. Drug manufacturers can deal with pharmacies and aim to sell their own medication, which is a counterpart to a drug specified in the doctor’s prescription. In this study, the relationship between the two different entities by normalizing the data has been tried to be correlated with the statistical approach. With the results obtained, statistical analysis was made and the pharmaceutical manufacturers which are prone to fraud were further narrowed. As a result, it was ensured that the data pool, which required fraud detection, was narrowed and this determination was facilitated