João Carlos Félix Souza

Applying clustering and AHP methods for evaluating suspect healthcare claims

Abstract This paper seeks to present a model for the analysis of suspicious claims data from healthcare providers with the use of different clustering algorithms, and the application of the AHP multicriteria method for prioritizing the identified suspect entities for subsequent auditing. We begin with a brief overview of related works that have covered the application of the aforementioned techniques for investigating suspicious entities in the context of internal auditing and healthcare. After presenting the steps for the construction of our own model, we discuss our results. We determine that the application of clustering algorithms to our initial variables resulted in the automatic detection of almost all entities initially classified as suspect. Our AHP model then provided us with rational criteria for effectively and objectively ranking these entities for further investigation

Project-based learning course design: a service design approach

Engineering education is becoming increasingly focused on developing competences, creating meaningful learning experiences and paying special attention to professional profiles as required by accreditation bodies. Project-based learning (PBL) is one of the approaches that is regarded as an adequate response to the current demands of engineering education. PBL is, by definition, based on interdisciplinary integration, so the design process is based on complex interdisciplinary requirements and interactions demanding systematic and standardised approaches. This work aims to develop a service design framework for the development of a project-based curriculum, which is regarded as a specific interpretation of service design. A service design approach based on structure, process and outcome dimensions is related with a set of methodological dimensions. This framework is connected with curriculum development levels to build a design model for PBL courses. Finally, the model is applied to a PBL curriculum design process in a Production Engineering graduate degree.

Digitization of Government Services: Digitization Process Mapping

The search for improvement and standardization of the digitization of government services has led governments around the world to focus on solutions that seek satisfaction, engagement and involvement of society in general. In addition, governmental systems are seeking constantly to renew the digital governance environment through good planning, use of best practices, and offering greater opportunities to establish collaborative and participatory relationships among all stakeholders (Government and Society). This paper presents a systematic literature review of the digitization of services contributing to the knowledge of the processes and methodologies adopted by these governments to provide their services to the citizen. The main contribution of this work is the proposal of a process mapping model that can be adopted during the stages of providing digital services by interested agencies in offering services focused on the needs of the citizens. The proposed model can be used by any government agency or private company interested in updating its processes, tools and methods of digitization and services automation according to their necessities.

A Project-based Learning curricular approach in a Production Engineering Program

The Industrial Engineering undergraduate program offered at the University of Brasilia was structured on Project Based Learning (PBL) methodology. This innovative educational proposal allows the students to deploy their technical competencies through real problem solving situations. The methodology also stimulates the development of the students’ soft skills, by exposing them to a challenging environment. At the end of each project, the results are presented to an external agent, and are subsequently implemented. The objective of this paper is to present the evolution of the PSP courses, which adopt as guidelines both the PMBOK project management framework, as well as content from specific technical courses related to the project’s subject. One other relevant aspect of the PSP courses is their involvement of both undergraduate and graduate students from different Engineering areas, such as Industrial, Mechanical and Civil Engineering, which serves to foster a more holistic and integrated problem-solving skillset.

Employment multicriteria with analytic hierarchy process for corporate risk analysis and sectored of information technology in health in the Brazilian army

This article presents the partial results of a research, which was used advanced programming with Analytic Hierarchy Process (AHP) using Expert Choice software to identify critical components of Information Technology (IT) that impact an organization and its relationship with the strategic objectives. The study is a qualitative and quantitative approach; with a literature search needed for its theoretical framework; the its development, with details of Delphi, AHP, Software Expert Choice. During the research, it created a model for this work with ABNT standards (ISO 27005, 38500 and 31000).

Risk Analysis and Quantitative Methods for Mobile Broadband Forecasting in Brazil

This study proposes the implementation of risk management as recommended in ISO 31000, to increase the efficiency and effectiveness in achieving one of the strategic objectives of the National Telecommunications Agency, namely: Expand the access and use of services, with quality and suitable price. As a specific goal sought to the provisions of the Brazilian Budget Plan, known as PPA 2016-2019, with the target set for mobile broadband reaches 90% of mobile accesses in 2019. Thus, materials were collected and theoretical basis to start the management process risk based primarily on ISO 31000, integrated with practices available to the public service as well as the regulations and others issues. By this work, it will be determined the internal and external context so that in a next step can be identified, evaluated and managed the risks involved in this process through specific tools described in ISO 31010. This paper shows that the structured process risk management can contribute to better governance and the achievement of its strategic objectives.

Predictive Models on Tax Refund Claims - Essays of Data Mining in Brazilian Tax Administration

One of the main goals of every tax administration is safeguarding tax justice. For that matter, accurate taxpayers’ auditing selection plays an important role. Current scenario of economic recession, budget cuts and tax professionals’ hiring difficulty combined with growth of both population and number of enterprises presents the necessity of a more efficiently approach from tax administration in order to meet its objectives. The present work intends to show how data mining techniques usage helps better understand the profile of non compliant tax payers who claim for tax refunds. Moreover, we present results on the adoption of predictive models towards selection improvement of those who claims that are more likely to be rejected in Federal Revenue of Brazil (RFB). Preliminary results shows that this approach is an efficient way for selecting tax payers rather than not using it.