Healthcare Fraud: Auditing and Detection Guide, 2nd Edition

Forensic Application of Data Mapping and Data Mining

The blend of the two methodologies creates a growing body of science referred to as exploratory data analysis (EDA). EDA in the healthcare environment can be broken down further. First, a review of forensics: The term forensic, in essence, represents “legal” or “related to courts” (from Latin, it means “before the forum”). This means that the information derived from the intelligence from EDA may be suitable for use in court. The science component can be broken down by any process or system that has an objective methodology that can be repeated by a third party utilizing a scientifically defined method. Therefore, with EDA, forensic science is using the application of EDA scientific methodology to answer questions that may be of interest to the legal system or legal proceeding.

The scientific method embodies the techniques of mapping, mining, auditing, and investigating a query; acquiring new intelligence; and corroborating previous intelligence. It is a process that can be measured, observed, and repeated by a third party. This process is subject to principles of reasoning. In essence, the reasoning process includes deriving the same or similar conclusions from defined theories using a defined methodology. Two types of reasoning will be reviewed.

The first is deductive reasoning: A conclusion is discerned by the theory or premise of previously known facts. If the theory is correct, then the conclusion must be true. Inference ...