Ateneo collaborates on pioneering machine learning study for fraud detection in PhilHealth claims management

PhilHealth is stepping into the future of health financing with pioneering research on using machine learning to detect fraud in its claims management process. The report, "Use of Machine Learning for Fraud Detection Within the Claims Management Process in the Philippines: Insights from the National Health Insurance Scheme PhilHealth," is part of the World Health Organization’s (WHO) country case study series on digital technologies for health financing.

The project brought together experts from WHO, PhilHealth, and Ateneo de Manila University, with significant contributions from Jovita Aragona, PhilHealth’s former Senior Vice President and Chief Information Officer, and Dr. Dennis Batangan, (Ateneo de Manila University, School of Social Sciences - Institute of Philippine Culture). Each study examined the relationship between machine learning and claims to avoid fraud and institute a transparent health insurance system in the Philippines.

Dr Graham Harrison, from the WHO’s Country Office in the Philippines and international reviewers provided support and input. 

The Canadian government, the Swiss Agency for Development Cooperation (DEZA), and the WHO-European Union UHC Partnership funded the project.

This is more than just a tech innovation—a move toward a healthier, more equitable future.

For more information, you may access the research at this link