Software supported model suggestion for combating abuse in the health sector in social security system

In this study; The evaluation of abuses in the health sector as an important problem area in the social security system and the use of software supported models in combating these abuses have been investigated. In this context; the areas of abuses in the health system are investigated, answers were sought to the questions of why these areas are used, whether the current situation of the social security institution is sufficient or not in combating the abuses, and what the contribution of developing technologies to this struggle process is. In this context, the prominent innovations in combatting against abuses around the world, the developing technologies and how the Social Security Institution should adapt these technologies were examined. As a result of the researches; It has been observed that the information technologies are used extensively in the world, countries are rapidly starting to transition to the digital state in order to digitize data and to make business processes compatible with automation, the traditional understanding of audit has been replaced by the transition to an audit model based on inter-agency cooperation and risk analysis. It has been evaluated that The Social Security Institution could not technologically integrate the intended unification with the reform, the existing methods in combatting are not effective, it has not been able to adapt business processes to automation. It has been concluded that the data in the hands of the institution is very comprehensive, and it will have an effective and efficient audit structure beyond the current audit results in the fight against abuse in the health sector by designing its processes in accordance with automation through inter-institutional cooperation and by effectively using information Technologies, and by developing software-supported control models. In this context, a sample program called the Anti-Fraud Information System (SUMBİS) has been prepared.