An investigation of healthcare fraud detection techniques in Nigerian hospitals: A study of hospitals in Kwara State
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Background of the study
Healthcare fraud, which involves the intentional deception or misrepresentation by healthcare providers to gain financial benefits, is a growing concern in Nigeria's healthcare system. In Kwara State, like many parts of the country, healthcare fraud manifests in various forms, including false billing, kickbacks, and unnecessary medical procedures (Ademola & Lawal, 2023). The financial implications of healthcare fraud are significant, leading to the diversion of resources meant for patient care, inefficiencies in hospital operations, and a loss of trust in healthcare institutions (Akinola et al., 2024).
Detecting healthcare fraud in Nigerian hospitals has been challenging due to the lack of robust systems and technologies for monitoring and auditing healthcare transactions (Olayemi & Adebayo, 2024). However, several techniques, such as data mining, anomaly detection, and forensic accounting, have been proposed as potential solutions to identify fraudulent activities in healthcare settings (Ogunleye et al., 2025). Hospitals in Kwara State, particularly public hospitals, often lack the necessary resources and technological tools to detect fraud effectively, further exacerbating the issue.
This study aims to investigate the effectiveness of healthcare fraud detection techniques in hospitals in Kwara State and evaluate their impact on reducing fraudulent activities.
Statement of the problem
Healthcare fraud is a serious issue in Nigerian hospitals, particularly in Kwara State, where limited resources and weak monitoring mechanisms make it difficult to detect and prevent fraudulent activities. The lack of effective fraud detection systems leads to financial losses, inefficient service delivery, and poor patient care. There is a need to investigate the current fraud detection techniques used in hospitals in Kwara State and assess their effectiveness in preventing healthcare fraud (Oluwole et al., 2023).
Objectives of the study
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To assess the effectiveness of healthcare fraud detection techniques in hospitals in Kwara State.
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To identify the challenges faced by hospitals in Kwara State in detecting and preventing healthcare fraud.
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To recommend strategies for improving healthcare fraud detection in hospitals in Kwara State.
Research questions
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How effective are the current healthcare fraud detection techniques in hospitals in Kwara State?
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What challenges do hospitals in Kwara State face in detecting and preventing healthcare fraud?
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What strategies can be adopted to improve fraud detection techniques in hospitals in Kwara State?
Research hypotheses
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The current healthcare fraud detection techniques in Kwara State hospitals are ineffective in preventing fraudulent activities.
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Lack of resources and inadequate training are significant challenges to effective fraud detection in Kwara State hospitals.
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Implementing advanced fraud detection techniques and increasing staff training will reduce healthcare fraud in Kwara State hospitals.
Scope and limitations of the study
This study will focus on hospitals in Kwara State that have implemented fraud detection mechanisms. The research will examine the effectiveness of these techniques and the challenges encountered in their implementation. Limitations may include restricted access to data on fraudulent activities and reluctance from hospital staff to participate in interviews.
Definitions of terms
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Healthcare Fraud: The intentional misrepresentation or falsification of healthcare claims, leading to financial gain at the expense of patients and healthcare institutions.
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Fraud Detection Techniques: Methods and systems used to identify and prevent fraudulent activities, including data analysis, audits, and forensic investigation.
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Forensic Accounting: The application of accounting principles to detect financial fraud and investigate financial crimes.
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