A blockchain-based framework for enhancing fraud detection, transparency, and efficiency in health insurance claims

Abstract

The implementation of blockchain technology in healthcare facilities has the potential to transform patient data, insurance administration, and healthcare services. With a focus on insurance administration, this study presents a solidity-based smart contract architecture designed to maximise the healthcare ecosystem. Important processes, including insurance claims, doctors and management, patient insurance registration, and hospital administration, can be automated through the contract. By keeping patient data, insurance plans, hospital information, and related transactions on a decentralised ledger, the contract guarantees security, transparency, and immutability while eliminating the need for intermediaries. The suggested framework makes sure that entities can share data safely and quickly. We have used the scyther tool to check the security of the protocol and show that it is strong enough to protect against authentication threats. Furthermore, for this proposed health insurance system, the author focuses on combining insurance and healthcare, guaranteeing automated claim approvals, safe data management, and fraud protection. The contract creates a unique policy number to ensure that each patient has only one active insurance policy. Patients submit insurance claims, which the pharmacy and the hospital must approve. We used Solidity with Remix IDE, a JavaScript-based platform available on browser and desktop. Remix integrates with Web3 and Ganache, enabling efficient testing, deployment, and blockchain interaction, making it ideal for developing Ethereum-based healthcare applications.