%0期刊文章%@ 1438-8871 %I JMIR出版物%V 22%卡塔尔世界杯8强波胆分析 N 9% P e18623 %T打击医疗欺诈和滥用:一个区块链反欺诈框架的概念化和原型研究% a Mackey,Tim Ken % a Miyachi,Ken % a Fung,Danny % a Qian,Samson % a Short,James %+加州大学圣地亚哥分校医学院麻醉科和传染病与全球公共卫生学部，La Jolla大道8950号，A124, CA, 92037，美国，1 9514914161，tmackey@ucsd.edu %K欺诈%K区块链%K医疗信息学%K医疗保健交付%K医疗保健%K信息科学%D 2020 %7 10.9.2020 %9原始论文%J J医疗互联网Res %G英语%X背景:估计26亿美元的损失归因于医疗保健欺诈和滥用。通过传统的医疗保健索赔核实和报销，医疗保健提供者在向患者提供服务后提交索赔，然后由付款人核实和报销。然而，这个过程忽略了一个关键的涉众:服务实际为其提供的患者。这种缺乏患者参与带来了欺诈和滥用的风险。区块链技术可以实现透明的安全数据管理，从而降低医疗欺诈和滥用的风险。目的:本研究的目的是开发一个框架，使用区块链以不可变的格式记录索赔数据和交易，并使患者充当验证节点，以帮助检测和防止医疗欺诈和滥用。方法:我们使用关键区块链工具和应用层开发了一个医疗欺诈和滥用区块链技术框架和原型，包括共识算法、智能合约、令牌和基于以太坊平台(以太坊基金会)数字身份的治理。结果:我们的技术框架映射到索赔裁决过程，并专注于医疗保险索赔，以美国医疗保险和医疗补助服务中心(CMS)为中心机构。 A prototype of the framework system was developed using the blockchain platform Ethereum (Ethereum Foundation), with its design features, workflow, smart contract functions, system architecture, and software implementation outlined. The software stack used to build the system consisted of a front-end user interface framework, a back-end processing server, and a blockchain network. React was used for the user interface framework, and NodeJS and an Express server were used for the back-end processing server; Solidity was the smart contract language used to interact with a local Ethereum blockchain network. Conclusions: The proposed framework and the initial prototype have the potential to improve the health care claims process by using blockchain technology for secure data storage and consensus mechanisms, which make the claims adjudication process more patient-centric for the purposes of identifying and preventing health care fraud and abuse. Future work will focus on the use of synthetic or historic CMS claims data to assess the real-world viability of the framework. %M 32909952 %R 10.2196/18623 %U //www.mybigtv.com/2020/9/e18623/ %U https://doi.org/10.2196/18623 %U http://www.ncbi.nlm.nih.gov/pubmed/32909952