Multivariate Anomaly Detection in Medicare using Model Residuals and Probabilistic Programming

AAAI Conferences

Anomalies in healthcare claims data can be indicative of possible fraudulent activities, contributing to a significant portion of overall healthcare costs. Medicare is a large government run healthcare program that serves the needs of the elderly in the United States. The increasing elderly population and their reliance on the Medicare program create an environment with rising costs and increased risk of fraud. The detection of these potentially fraudulent activities can recover costs and lessen the overall impact of fraud on the Medicare program. In this paper, we propose a new method to detect fraud by discovering outliers, or anomalies, in payments made to Medicare providers. We employ a multivariate outlier detection method split into two parts. In the first part, we create a multivariate regression model and generate corresponding residuals. In the second part, these residuals are used as inputs into a generalizable univariate probability model. We create this Bayesian probability model using probabilistic programming. Our results indicate our model is robust and less dependent on underlying data distributions, versus Mahalanobis distance. Moreover, we are able to demonstrate successful anomaly detection, within Medicare specialties, providing meaningful results for further investigation.

Estimating and Controlling the False Discovery Rate for the PC Algorithm Using Edge-Specific P-Values Machine Learning

The PC algorithm allows investigators to estimate a complete partially directed acyclic graph (CPDAG) from a finite dataset, but few groups have investigated strategies for estimating and controlling the false discovery rate (FDR) of the edges in the CPDAG. In this paper, we introduce PC with p-values (PC-p), a fast algorithm which robustly computes edge-specific p-values and then estimates and controls the FDR across the edges. PC-p specifically uses the p-values returned by many conditional independence tests to upper bound the p-values of more complex edge-specific hypothesis tests. The algorithm then estimates and controls the FDR using the bounded p-values and the Benjamini-Yekutieli FDR procedure. Modifications to the original PC algorithm also help PC-p accurately compute the upper bounds despite non-zero Type II error rates. Experiments show that PC-p yields more accurate FDR estimation and control across the edges in a variety of CPDAGs compared to alternative methods.

Audits as Evidence: Experiments, Ensembles, and Enforcement Machine Learning

We develop tools for utilizing correspondence experiments to detect illegal discrimination by individual employers. Employers violate US employment law if their propensity to contact applicants depends on protected characteristics such as race or sex. We establish identification of higher moments of the causal effects of protected characteristics on callback rates as a function of the number of fictitious applications sent to each job ad. These moments are used to bound the fraction of jobs that illegally discriminate. Applying our results to three experimental datasets, we find evidence of significant employer heterogeneity in discriminatory behavior, with the standard deviation of gaps in job-specific callback probabilities across protected groups averaging roughly twice the mean gap. In a recent experiment manipulating racially distinctive names, we estimate that at least 85% of jobs that contact both of two white applications and neither of two black applications are engaged in illegal discrimination. To assess the tradeoff between type I and II errors presented by these patterns, we consider the performance of a series of decision rules for investigating suspicious callback behavior under a simple two-type model that rationalizes the experimental data. Though, in our preferred specification, only 17% of employers are estimated to discriminate on the basis of race, we find that an experiment sending 10 applications to each job would enable accurate detection of 7-10% of discriminators while falsely accusing fewer than 0.2% of non-discriminators. A minimax decision rule acknowledging partial identification of the joint distribution of callback rates yields higher error rates but more investigations than our baseline two-type model. Our results suggest illegal labor market discrimination can be reliably monitored with relatively small modifications to existing audit designs.

Predictive Collective Variable Discovery with Deep Bayesian Models Machine Learning

Extending spatio-temporal scale limitations of models for complex atomistic systems considered in biochemistry and materials science necessitates the development of enhanced sampling methods. The potential acceleration in exploring the configurational space by enhanced sampling methods depends on the choice of collective variables (CVs). In this work, we formulate the discovery of CVs as a Bayesian inference problem and consider the CVs as hidden generators of the full-atomistic trajectory. The ability to generate samples of the fine-scale atomistic configurations using limited training data allows us to compute estimates of observables as well as our probabilistic confidence on them. The methodology is based on emerging methodological advances in machine learning and variational inference. The discovered CVs are related to physicochemical properties which are essential for understanding mechanisms especially in unexplored complex systems. We provide a quantitative assessment of the CVs in terms of their predictive ability for alanine dipeptide (ALA-2) and ALA-15 peptide.

Robust data-driven approach for predicting the configurational energy of high entropy alloys Machine Learning

High entropy alloys (HEAs) have been increasingly attractive as promising next-generation materials due to their various excellent properties. It's necessary to essentially characterize the degree of chemical ordering and identify order-disorder transitions through efficient simulation and modeling of thermodynamics. In this study, a robust data-driven framework based on Bayesian approaches is proposed and demonstrated on the accurate and efficient prediction of configurational energy of high entropy alloys. The proposed effective pair interaction (EPI) model with ensemble sampling is used to map the configuration and its corresponding energy. Given limited data calculated by first-principles calculations, Bayesian regularized regression not only offers an accurate and stable prediction but also effectively quantifies the uncertainties associated with EPI parameters. Compared with the arbitrary determination of model complexity, we further conduct a physical feature selection to identify the truncation of coordination shells in EPI model using Bayesian information criterion. The results achieve efficient and robust performance in predicting the configurational energy, particularly given small data. The developed methodology is applied to study a series of refractory HEAs, i.e. NbMoTaW, NbMoTaWV and NbMoTaWTi where it is demonstrated how dataset size affects the confidence we can place in statistical estimates of configurational energy when data are sparse.