International Social Security Association (ISSA) (2024) Report (multilateral / development partner)

Detecting fraud in health care through emerging technologies

ISSA

Ref: SRC-004-KOR-001

https://www.issa.int/analysis/detecting-fraud-health-care-through-emerging-technologies

Accessed: 3/27/2026

Summary

ISSA analysis article documenting how social security institutions use emerging technologies for healthcare fraud detection. Covers Korea NHIS hybrid detection system combining rule-based and AI predictive models, including details on the transition from experiential screening to data-driven management. Reports 2023 FDS enhancement uncovering KRW 18.534 billion in unjust enrichment.

View Harvard reference

ISSA (2024) 'Detecting fraud in health care through emerging technologies', issa.int. Available at: https://www.issa.int/analysis/detecting-fraud-health-care-through-emerging-technologies (Accessed: 27 March 2026).

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Linked Cases (1)

KOR-001 KOR Full Production Deployment

National Health Insurance Service (NHIS) – Machine Learning-Based Fraud Detection and Prediction System

Social insurance Classical ML