This public dataset was created by the Centers for Medicare & Medicaid Services. The data summarizes the utilization and payments for procedures, services, and prescription drugs provided to Medicare beneficiaries by specific inpatient and outpatient hospitals. The dataset includes the following data - common inpatient and outpatient services from 2012 to 2015.

Providers determine what they will charge for items, services, and procedures provided to patients and these charges are the amount that providers bill for an item, service, or procedure.

Abstract

This is a Medicare dataset released by the Center for Medicare and Medicaid Services (CMS) and accessed via BigQuery. All data is from 2014.

Documentation

For more information regarding the CMS data, click here.

From BigQuery:

This public dataset was created by the Centers for Medicare & Medicaid Services. The data summarizes the utilization and payments for procedures, services, and prescription drugs provided to Medicare beneficiaries by specific inpatient and outpatient hospitals, physicians, and other suppliers. The dataset includes the following data - common inpatient and outpatient services, all physician and other supplier procedures and services, and all Part D prescriptions.

Providers determine what they will charge for items, services, and procedures provided to patients and these charges are the amount that providers bill for an item, service, or procedure.

Content

More details about each file are in the individual file descriptions.

Context

This is a dataset hosted by the Centers for Medicare & Medicaid Services (CMS). The organization has an open data platform found here and they update their information according the amount of data that is brought in. Explore CMS's Data using Kaggle and all of the data sources available through the CMS organization page!

• Update Frequency: This dataset is updated daily.

Acknowledgements

This dataset is maintained using Socrata's API and Kaggle's API. Socrata has assisted countless organizations with hosting their open data and has been an integral part of the process of bringing more data to the public.

This dataset is distributed under the following licenses: Public Domain, NA

Content

The hospital readmission rate PUF presents nation-wide information about inpatient hospital stays that occurred within 30 days of a previous inpatient hospital stay (readmissions) for Medicare fee-for-service beneficiaries. The readmission rate equals the number of inpatient hospital stays classified as readmissions divided by the number of index stays for a given month. Index stays include all inpatient hospital stays except those where the primary diagnosis was cancer treatment or rehabilitation. Readmissions include stays where a beneficiary was admitted as an inpatient within 30 days of the discharge date following a previous index stay, except cases where a stay is considered always planned or potentially planned. Planned readmissions include admissions for organ transplant surgery, maintenance chemotherapy/immunotherapy, and rehabilitation.

This dataset has several limitations. Readmissions rates are unadjusted for age, health status or other factors. In addition, this dataset reports data for some months where claims are not yet final. Data published for the most recent six months is preliminary and subject to change. Final data will be published as they become available, although the difference between preliminary and final readmission rates for a given month is likely to be less than 0.1 percentage point.

Data Source: The primary data source for these data is the CMS Chronic Condition Data Warehouse (CCW), a database with 100% of Medicare enrollment and fee-for-service claims data. For complete information regarding data in the CCW, visit http://ccwdata.org/index.php. Study Population: Medicare fee-for-service beneficiaries with inpatient hospital stays.

Context

This is a dataset hosted by the Centers for Medicare & Medicaid Services (CMS). The organization has an open data platform found here and they update their information according the amount of data that is brought in. Explore CMS's Data using Kaggle and all of the data sources available through the CMS organization page!

• Update Frequency: This dataset is updated daily.

Acknowledgements

This dataset is maintained using Socrata's API and Kaggle's API. Socrata has assisted countless organizations with hosting their open data and has been an integral part of the process of bringing more data to the public.

Cover photo by Justyn Warner on Unsplash
Unsplash Images are distributed under a unique Unsplash License.

This dataset is distributed under NA

Context

In the United States, Medicare is a single-payer, national social insurance program administered by the U.S. federal government since 1966. It provides health insurance for Americans aged 65 and older who have worked and paid into the system through the payroll tax. Source: https://en.wikipedia.org/wiki/Medicare_(United_States)

Content

This public dataset was created by the Centers for Medicare & Medicaid Services. The data summarizes the utilization and payments for procedures, services, and prescription drugs provided to Medicare beneficiaries by specific inpatient and outpatient hospitals, physicians, and other suppliers. The dataset includes the following data.

Common inpatient and outpatient services All physician and other supplier procedures and services All Part D prescriptions. Providers determine what they will charge for items, services, and procedures provided to patients and these charges are the amount that providers bill for an item, service, or procedure.

Fork this kernel to get started.

Acknowledgements

https://bigquery.cloud.google.com/dataset/bigquery-public-data:medicare

https://cloud.google.com/bigquery/public-data/medicare

Dataset Source: Center for Medicare and Medicaid Services. This dataset is publicly available for anyone to use under the following terms provided by the Dataset Source - http://www.data.gov/privacy-policy#data_policy — and is provided "AS IS" without any warranty, express or implied, from Google. Google disclaims all liability for any damages, direct or indirect, resulting from the use of the dataset.

Banner Photo by @rawpixel from Unplash.

Inspiration

What is the total number of medications prescribed in each state?

What is the most prescribed medication in each state?

What is the average cost for inpatient and outpatient treatment in each city and state?

Which are the most common inpatient diagnostic conditions in the United States?

Which cities have the most number of cases for each diagnostic condition?

What are the average payments for these conditions in these cities and how do they compare to the national average?

This dataset represents weekly hospital respiratory data and metrics aggregated to national and state/territory levels reported to CDC’s National Health Safety Network (NHSN) beginning August 2020. Data for reporting dates through April 30, 2024 represent data reported during a previous mandated reporting period as specified by the HHS Secretary. Data for reporting dates May 1, 2024 – October 31, 2024 represent voluntarily reported data in the absence of a mandate. Data for reporting dates beginning November 1, 2024 represent data reported during a current mandated reporting period. All data and metrics capturing information on respiratory syncytial virus (RSV) were voluntarily reported until November 1, 2024. All data included in this dataset represent aggregated counts, and include metrics capturing information specific to hospital capacity, occupancy, hospitalizations, and new hospital admissions with corresponding metrics indicating reporting coverage for a given reporting week. NHSN monitors national and local trends in healthcare system stress and capacity for all acute care and critical access hospitals in the United States.For more information on the reporting mandate per the Centers for Medicare and Medicaid Services (CMS) requirements, visit: Updates to the Condition of Participation (CoP) Requirements for Hospitals and Critical Access Hospitals (CAHs) To Report Acute Respiratory Illnesses.For more information regarding NHSN’s collection of these data, including full reporting guidance, visit: NHSN Hospital Respiratory Data.Source: CDC National Healthcare Safety Network (NHSN).Data source description (updated November 15, 2024): As of October 9, 2024, Hospital Respiratory Data (HRD; formerly Respiratory Pathogen, Hospital Capacity, and Supply data or 'COVID-19 hospital data') are reported to HHS through CDC's National Healthcare Safety Network (NHSN) based on updated requirements from the Centers for Medicare and Medicaid Services (CMS). These data were voluntarily reported to NHSN May 1, 2024 until November 1, 2024, at which time CMS began requiring acute care and critical access hospitals to electronically report information via NHSN about COVID-19, influenza, and RSV, hospital bed census and capacity. Hospital bed capacity and occupancy data for all patients and for patients with COVID-19 or influenza for collection dates prior to May 1, 2024, represent data reported during a previously mandated reporting period as specified by the HHS Secretary, and data for collection dates May 1, 2024 – October 31, 2024 represent data reported voluntarily to NHSN. All RSV data through October 31, 2024 represent voluntarily reported data; as such, all voluntarily reported data included in this dataset represent reporting hospitals only for a given week and might not be complete or representative of all hospitals during the specified reporting periods.NHSN monitors national and local trends in healthcare system stress and capacity for all acute care and critical access hospitals in the United States. Data reported by hospitals to NHSN represent aggregated counts and include metrics capturing information specific to hospital capacity, occupancy, hospitalizations, and admissions. Find more information about reporting to NHSN: https://www.cdc.gov/nhsn/psc/hospital-respiratory-reporting.html.Data quality: While CDC reviews reported data for completeness and errors and corrects those found, some reporting errors might still exist within the data. CDC and partners work with reporters to correct these errors and update the data in subsequent weeks. Data reported as of December 1, 2020 are subject to thorough, routine data quality review procedures, including identifying and excluding invalid values from metric calculations and application of error correction methodology; data prior to this date may have anomalies that are not yet resolved. Data prior to August 1, 2020, are unavailable. As a result of data quality implementation and submission of any backfilled data, data and metrics might fluctuate or change week-over-week after initial posting.Inclusion criteria and metric calculations:Facility types and status: Many hospital subtypes, including acute care and critical access hospitals, are included in the metric calculations displayed on this page. Psychiatric, rehabilitation, and religious non-me

MAX data is a set of person-level data files on Medicaid eligibility, service utilization, and payments in the United States of America. The MAX data are extracted from the Medicaid Statistical Information System (MSIS) and are created to support research and policy analysis. The MAX development process combines MSIS initial claims, interim claims, voids, and adjustments for a given service into final action events. MAX datasets include inpatient data, long-term care files, other services, prescription drug files, and person summary files.

NAPSG Foundation simply changed the symbology based on bed utilization and filter set to Hospital Type is not 'Psychiatric Hospital'. NAPSG Foundation is not the host of this dataset, see notes below for more details.Also - it is not clear how often the bed utilization rate updates, but it is now presumed to be 4x per year. THIS IS NOT A REAL-TIME DATASET.Definitive Healthcare is the leading provider of data, intelligence, and analytics on healthcare organizations and practitioners. In this service, Definitive Healthcare provides intelligence on the numbers of licensed beds, staffed beds, ICU beds, and the bed utilization rate for the hospitals in the United States. Please see the following for more details about each metric, data was last updated on 17 March 2020:Number of Licensed beds: is the maximum number of beds for which a hospital holds a license to operate; however, many hospitals do not operate all the beds for which they are licensed. This number is obtained through DHC Primary Research. Licensed beds for Health Systems are equal to the total number of licensed beds of individual Hospitals within a given Health System. Number of Staffed Bed: is defined as an "adult bed, pediatric bed, birthing room, or newborn ICU bed (excluding newborn bassinets) maintained in a patient care area for lodging patients in acute, long term, or domiciliary areas of the hospital." Beds in labor room, birthing room, post-anesthesia, postoperative recovery rooms, outpatient areas, emergency rooms, ancillary departments, nurses and other staff residences, and other such areas which are regularly maintained and utilized for only a portion of the stay of patients (primarily for special procedures or not for inpatient lodging) are not termed a bed for these purposes. Definitive Healthcare sources Staffed Bed data from the Medicare Cost Report or Proprietary Research as needed. As with all Medicare Cost Report metrics, this number is self-reported by providers. Staffed beds for Health Systems are equal to the total number of staffed beds of individual Hospitals within a given Health System. Total number of staffed beds in the US should exclude Hospital Systems to avoid double counting. ICU beds are likely to follow the same logic as a subset of Staffed beds. Number of ICU Beds - ICU (Intensive Care Unit) Beds: are qualified based on definitions by CMS, Section 2202.7, 22-8.2. These beds include ICU beds, burn ICU beds, surgical ICU beds, premature ICU beds, neonatal ICU beds, pediatric ICU beds, psychiatric ICU beds, trauma ICU beds, and Detox ICU beds. Bed Utilization Rate: is calculated based on metrics from the Medicare Cost Report: Bed Utilization Rate = Total Patient Days (excluding nursery days)/Bed Days AvailablePotential Increase in Bed Capacity: This metric is computed by subtracting “Number of Staffed Beds from Number of Licensed beds” (Licensed Beds – Staffed Beds). This would provide insights into scenario planning for when staff can be shifted around to increase available bed capacity as needed. Hospital Definition: Definitive Healthcare defines a hospital as a healthcare institution providing inpatient, therapeutic, or rehabilitation services under the supervision of physicians. In order for a facility to be considered a hospital it must provide inpatient care. Hospital types are defined by the last four digits of the hospital’s Medicare Provider Number. If the hospital does not have a Medicare Provider Number, Definitive Healthcare determines the Hospital type by proprietary research. Hospital Types:· Short Term Acute Care Hospital (STAC)o Provides inpatient care and other services for surgery, acute medical conditions, or injurieso Patients care can be provided overnight, and average length of stay is less than 25 days· Critical Access Hospital (CAH)o 25 or fewer acute care inpatient bedso Located more than 35 miles from another hospitalo Annual average length of stay is 96 hours or less for acute care patientso Must provide 24/7 emergency care serviceso Designation by CMS to reduce financial vulnerability of rural hospitals and improve access to healthcare· Religious Non-Medical Health Care Institutionso Provide nonmedical health care items and services to people who need hospital or skilled nursing facility care, but for whom that care would be inconsistent with their religious beliefs· Long Term Acute Care Hospitalso Average length of stay is more than 25 dayso Patients are receiving acute care - services often include respiratory therapy, head trauma treatment, and pain management· Rehabilitation Hospitalso Specializes in improving or restoring patients' functional abilities through therapies· Children’s Hospitalso Majority of inpatients under 18 years old· Psychiatric Hospitalso Provides inpatient services for diagnosis and treatment of mental illness 24/7o Under the supervision of a physician· Veteran's Affairs (VA) Hospital o Responsible for the care of war veterans and other retired military personnelo Administered by the U.S. VA, and funded by the federal government· Department of Defense (DoD) Hospitalo Provides care for military service people (Army, Navy, Air Force, Marines, and Coast Guard), their dependents, and retirees (not all military service retirees are eligible for VA services) For more information please visit - https://www.definitivehc.com/ - or contact sales@definitivehc.com

Note - this is not real-time status information, the data represents bed utilization based on annual estimates of how many beds are used versus available.Definitive Healthcare is the leading provider of data, intelligence, and analytics on healthcare organizations and practitioners. In this service, Definitive Healthcare provides intelligence on the numbers of licensed beds, staffed beds, ICU beds, and the bed utilization rate for the hospitals in the United States. Please see the following for more details about each metric, data was last updated on 17 March 2020:

Number of Licensed beds: is the maximum number of beds for which a hospital holds a license to operate; however, many hospitals do not operate all the beds for which they are licensed. This number is obtained through DHC Primary Research. Licensed beds for Health Systems are equal to the total number of licensed beds of individual Hospitals within a given Health System.

Number of Staffed Bed: is defined as an "adult bed, pediatric bed, birthing room, or newborn ICU bed (excluding newborn bassinets) maintained in a patient care area for lodging patients in acute, long term, or domiciliary areas of the hospital." Beds in labor room, birthing room, post-anesthesia, postoperative recovery rooms, outpatient areas, emergency rooms, ancillary departments, nurses and other staff residences, and other such areas which are regularly maintained and utilized for only a portion of the stay of patients (primarily for special procedures or not for inpatient lodging) are not termed a bed for these purposes. Definitive Healthcare sources Staffed Bed data from the Medicare Cost Report or Proprietary Research as needed. As with all Medicare Cost Report metrics, this number is self-reported by providers. Staffed beds for Health Systems are equal to the total number of staffed beds of individual Hospitals within a given Health System. Total number of staffed beds in the US should exclude Hospital Systems to avoid double counting. ICU beds are likely to follow the same logic as a subset of Staffed beds.

Number of ICU Beds - ICU (Intensive Care Unit) Beds: are qualified based on definitions by CMS, Section 2202.7, 22-8.2. These beds include ICU beds, burn ICU beds, surgical ICU beds, premature ICU beds, neonatal ICU beds, pediatric ICU beds, psychiatric ICU beds, trauma ICU beds, and Detox ICU beds.

Bed Utilization Rate: is calculated based on metrics from the Medicare Cost Report: Bed Utilization Rate = Total Patient Days (excluding nursery days)/Bed Days Available

Potential Increase in Bed Capacity: This metric is computed by subtracting “Number of Staffed Beds from Number of Licensed beds” (Licensed Beds – Staffed Beds). This would provide insights into scenario planning for when staff can be shifted around to increase available bed capacity as needed.

Hospital Definition: Definitive Healthcare defines a hospital as a healthcare institution providing inpatient, therapeutic, or rehabilitation services under the supervision of physicians. In order for a facility to be considered a hospital it must provide inpatient care.

Hospital types are defined by the last four digits of the hospital’s Medicare Provider Number. If the hospital does not have a Medicare Provider Number, Definitive Healthcare determines the Hospital type by proprietary research.

Hospital Types:

·
Short Term Acute Care Hospital (STAC)

o
Provides inpatient care and other services for surgery, acute medical conditions, or injuries

o
Patients care can be provided overnight, and average length of stay is less than 25 days

·
Critical Access Hospital (CAH)

o
25 or fewer acute care inpatient beds

o
Located more than 35 miles from another hospital

o
Annual average length of stay is 96 hours or less for acute care patients

o
Must provide 24/7 emergency care services

o
Designation by CMS to reduce financial vulnerability of rural hospitals and improve access to healthcare

·
Religious Non-Medical Health Care Institutions

o
Provide nonmedical health care items and services to people who need hospital or skilled nursing facility care, but for whom that care would be inconsistent with their religious beliefs

·
Long Term Acute Care Hospitals

o
Average length of stay is more than 25 days

o
Patients are receiving acute care - services often include respiratory therapy, head trauma treatment, and pain management

·
Rehabilitation Hospitals

o
Specializes in improving or restoring patients' functional abilities through therapies

·
Children’s Hospitals

o
Majority of inpatients under 18 years old

·
Psychiatric Hospitals

o
Provides inpatient services for diagnosis and treatment of mental illness 24/7

o
Under the supervision of a physician

·
Veteran's Affairs (VA) Hospital

o
Responsible for the care of war veterans and other retired military personnel

o
Administered by the U.S. VA, and funded by the federal government

·
Department of Defense (DoD) Hospital

o
Provides care for military service people (Army, Navy, Air Force, Marines, and Coast Guard), their dependents, and retirees (not all military service retirees are eligible for VA services)

This dataset represents weekly hospital respiratory data and metrics aggregated to national and state/territory levels reported to CDC’s National Health Safety Network (NHSN) beginning November 2024. Data and metrics included in this dataset are NOT updated or adjusted week-over-week after initial publication, and therefore represent data received at the time of publication for a given reporting week. All data included in this dataset represent aggregated counts, and include metrics capturing information specific to hospital capacity, occupancy, hospitalizations, and new hospital admissions with corresponding metrics indicating reporting coverage for a given reporting week. NHSN monitors national and local trends in healthcare system stress and capacity for all acute care and critical access hospitals in the United States.

For more information on the reporting mandate per the Centers for Medicare and Medicaid Services (CMS) requirements, visit: Updates to the Condition of Participation (CoP) Requirements for Hospitals and Critical Access Hospitals (CAHs) To Report Acute Respiratory Illnesses.

For more information regarding NHSN’s collection of these data, including full reporting guidance, visit: NHSN Hospital Respiratory Data.

Source: CDC National Healthcare Safety Network (NHSN).

• Data source description  (updated November 15, 2024): As of October 9, 2024, Hospital Respiratory Data (HRD; formerly Respiratory Pathogen, Hospital Capacity, and Supply data or 'COVID-19 hospital data') are reported to HHS through CDC's National Healthcare Safety Network (NHSN) based on updated requirements from the Centers for Medicare and Medicaid Services (CMS). These data were voluntarily reported to NHSN May 1, 2024 until November 1, 2024, at which time CMS began requiring acute care and critical access hospitals to electronically report information via NHSN about COVID-19, influenza, and RSV, hospital bed census and capacity. Hospital bed capacity and occupancy data for all patients and for patients with COVID-19 or influenza for collection dates prior to May 1, 2024, represent data reported during a previously mandated reporting period as specified by the HHS Secretary, and data for collection dates May 1, 2024 – October 31, 2024 represent data reported voluntarily to NHSN. All RSV data through October 31, 2024 represent voluntarily reported data; as such, all voluntarily reported data included in this dataset represent reporting hospitals only for a given week and might not be complete or representative of all hospitals during the specified reporting periods.
• NHSN monitors national and local trends in healthcare system stress and capacity for all acute care and critical access hospitals in the United States. Data reported by hospitals to NHSN represent aggregated counts and include metrics capturing information specific to hospital capacity, occupancy, hospitalizations, and admissions. Find more information about reporting to NHSN: https://www.cdc.gov/nhsn/psc/hospital-respiratory-reporting.html.
• Data quality: While CDC reviews reported data for completeness and errors and corrects those found, some reporting errors might still exist within the data. CDC and partners work with reporters to correct these errors and update the data in subsequent weeks. Data reported as of December 1, 2020 are subject to thorough, routine data quality review procedures, including identifying and excluding invalid values from metric calculations and application of error correction methodology; data prior to this date may have anomalies that are not yet resolved. Data prior to August 1, 2020, are unavailable. Data and metrics included in this dataset are NOT updated or adjusted week-over-week after initial publication, and therefore represent data received at the time of publication for a given reporting week.
• Inclusion criteria and metric calculations:
• Facility types and status: Many hospital subtypes, including acute care and critical access hospitals, are included in the metric calculations displayed on this page. Psychiatric, rehabilitation, and religious non-medical hospital types are excluded from calculations. Number of reporting hospitals is determined based on the NHSN unique hospital identifier and not aggregated to the CMS certification number (CCN). Only hospitals indicated as active reporters in NHSN are included.
• Bed occupancy metrics: hospitals that reported those data for Wednesday during a given week are included in the metric calculation, which are displayed as single day (i.e. Wednesday) values.
• New hospital admissions: hospitals that reported those data for an entire reporting week are included in the metric calculation, which are displayed as weekly totals. Under current reporting requirements, new admissions data are reported to represent the number of new admissions occurring on a given reporting date or during a given reporting week.
• Find full details on NHSN Hospital Respiratory Data (HRD) reporting guidance, including additional information on bed type definitions at https://www.cdc.gov/nhsn/psc/hospital-respiratory-reporting.html.

Archived datasets updated during the mandatory hospital reporting period from August 1, 2020, to April 30, 2024:

1. https://data.cdc.gov/Public-Health-Surveillance/Weekly-United-States-COVID-19-Hospitalization-Metr/akn2-qxic/about_data
2. https://data.cdc.gov/Public-Health-Surveillance/Weekly-United-States-COVID-19-Hospitalization-Metr/82ci-krud/about_data
3. https://data.cdc.gov/Public-Health-Surveillance/Respiratory-Virus-Response-RVR-United-States-Hospi/9t9r-e5a3/about_data
4. https://data.cdc.gov/Public-Health-Surveillance/Weekly-United-States-COVID-19-Hospitalization-Metr/7dk4-g6vg/about_data
5. https://data.cdc.gov/Public-Health-Surveillance/United-States-COVID-19-Hospitalization-Metrics-by-/39z2-9zu6/about_data

Archived datasets updated during the voluntary hospital reporting period from May 1, 2024, to October 31, 2024:

1. https://data.cdc.gov/Public-Health-Surveillance/Weekly-United-States-COVID-19-Hospitalization-Metr/akn2-qxic/about_data
2. https://data.cdc.gov/Public-Health-Surveillance/Weekly-United-States-Hospitalization-Metrics-by-Ju/ype6-idgy

Note: December 1st, 2025: Data for American Samoa (AS) for the November 16th, 2025 through November 22nd, 2025 reporting period are not available for the Weekly NHSN Hospital Respiratory Data report released on December 1st, 2025.

November 21st, 2025: Data for Commonwealth of the Northern Mariana Islands (CNMI) for the November 9th, 2025 through November 15th, 2025 reporting period are not available for the Weekly NHSN Hospital Respiratory Data report released on November 21st, 2025.

September 26th, 2025: The following columns were added to this dataset as of September 26th,

This data set and initial kernel is my first data set and analysis that I’m doing through R. I’m using the data from data.CMS.Gov for Inpatient Prospective Payment System Provider Summary forAll Diagnosis-Related Groups(DRG) - FY 2017. This data was published on the day that I started the analysis, 8/28/2019. It can be found here

I just recently started to teach myself R through books and online tutorials and the goal is to use these skills to stand out in my job and create future opportunities by leveraging data science skills. Eventually, I want to delve in to Machine Learning algorithms and how to apply them in the healthcare space. For now, the low hanging fruit is data analysis in a field I’m intimately familiar with.

A number of the code chunks here are mimicked from books or from others online that have done similar analysis. As I’m learning, I’m trying to emulate some of the best practices and techniques that others are using until I get familiar enough to understand and apply them to more unique problems. This is part of the reason why I’ve chosen a data set that was released today.

Any constructive critiques or suggestions are greatly appreciated. Also, if you can do more with the data, it would be greatly appreciated as I'll be able to see how others process and analyze the data.

Background

The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Provider Utilization and Payment Data Inpatient Public Use File (herein referred to as “Inpatient PUF”), with information on services and procedures provided to Medicare beneficiaries by hospital facilities. The Inpatient PUF contains hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG). The Inpatient PUF is available for fiscal years 2011 through 2015 and reflect 100% final-action (i.e., all claim adjustments have been resolved) IPPS discharges for the Medicare fee-for-service (FFS) population. Beginning with FY2014 data, all MS-DRG discharges are reported in the Inpatient PUF. Prior years of the Inpatient PUF (FY2011 through FY2013) are limited to the top 100 most frequently billed discharges.

Project Objectives Provider Fraud is one of the biggest problems facing Medicare. According to the government, the total Medicare spending increased exponentially due to frauds in Medicare claims. Healthcare fraud is an organized crime which involves peers of providers, physicians, beneficiaries acting together to make fraud claims.

Rigorous analysis of Medicare data has yielded many physicians who indulge in fraud. They adopt ways in which an ambiguous diagnosis code is used to adopt costliest procedures and drugs. Insurance companies are the most vulnerable institutions impacted due to these bad practices. Due to this reason, insurance companies increased their insurance premiums and as result healthcare is becoming costly matter day by day.

Healthcare fraud and abuse take many forms. Some of the most common types of frauds by providers are:

a) Billing for services that were not provided.

b) Duplicate submission of a claim for the same service.

c) Misrepresenting the service provided.

d) Charging for a more complex or expensive service than was actually provided.

e) Billing for a covered service when the service actually provided was not covered.

Problem Statement The goal of this project is to " predict the potentially fraudulent providers " based on the claims filed by them.along with this, we will also discover important variables helpful in detecting the behaviour of potentially fraud providers. further, we will study fraudulent patterns in the provider's claims to understand the future behaviour of providers.

Introduction to the Dataset For the purpose of this project, we are considering Inpatient claims, Outpatient claims and Beneficiary details of each provider. Lets s see their details :

A) Inpatient Data

This data provides insights about the claims filed for those patients who are admitted in the hospitals. It also provides additional details like their admission and discharge dates and admit d diagnosis code.

B) Outpatient Data

This data provides details about the claims filed for those patients who visit hospitals and not admitted in it.

C) Beneficiary Details Data

This data contains beneficiary KYC details like health conditions,regioregion they belong to etc.