Healthcare Insurance Fraud and Blockchain Interoperability: A Literature Review
Keywords:
Healthcare fraud; Healthcare fraud, insurance claims, fraud prevention, health systemsAbstract
Healthcare insurance fraud is a persistent global challenge, resulting in significant financial losses, undermining healthcare quality, and eroding public trust. Conventional fraud detection measures, such as audits and penalties, are insufficient for addressing systemic and organized schemes. Blockchain technology, particularly its interoperability features, offers opportunities for enhancing transparency, accountability, and secure data exchange across healthcare systems. This study systematically reviews the literature on healthcare insurance fraud. It examines the potential of blockchain interoperability to mitigate fraud, with a specific focus on its applicability to Oman’s healthcare sector. A systematic search was conducted in PubMed, Scopus, and Web of Science for publications between 2016 and 2024, using predefined keywords and Boolean operators. Eligible studies discussed healthcare fraud, blockchain, or interoperability. After duplicate removal, titles, abstracts, and full texts were screened against the inclusion criteria. A thematic synthesis approach was applied, supported by PRISMA guidelines. The search identified 1,245 studies, with an additional 32 retrieved from other sources. After removing duplicates, 1,050 records were screened, and 120 full-text articles were assessed for eligibility. Seventy-five were excluded for being non-healthcare-related, purely technical, or duplicates. In total, 45 studies were included. Findings indicate fraud typologies such as billing manipulation, collusion, and documentation falsification. Blockchain applications were most common in electronic health records and supply chain management, while interoperability-focused solutions in insurance claims remain limited. No Oman-specific studies were identified. Blockchain interoperability offers a promising, though underexplored, avenue for fraud prevention in health insurance. Its immutability, transparency, and automation through smart contracts could directly address systemic vulnerabilities in claims processing. The findings emphasize the need for empirical research, pilot projects, and supportive policy frameworks in Oman and other GCC countries to evaluate blockchain’s feasibility in healthcare insurance fraud prevention.
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