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.

Probabilistic Event Cascades for Alzheimer's disease

Neural Information Processing Systems

Accurate and detailed models of the progression of neurodegenerative diseases such as Alzheimer's (AD) are crucially important for reliable early diagnosis and the determination and deployment of effective treatments. In this paper, we introduce the ALPACA (Alzheimer's disease Probabilistic Cascades) model, a generative model linking latent Alzheimer's progression dynamics to observable biomarker data. In contrast with previous works which model disease progression as a fixed ordering of events, we explicitly model the variability over such orderings among patients which is more realistic, particularly for highly detailed disease progression models. We describe efficient learning algorithms for ALPACA and discuss promising experimental results on a real cohort of Alzheimer's patients from the Alzheimer's Disease Neuroimaging Initiative.

Learning From What You Don't Observe Artificial Intelligence

The process of diagnosis involves learning about the state of a system from various observations of symptoms or findings about the system. Sophisticated Bayesian (and other) algorithms have been developed to revise and maintain beliefs about the system as observations are made. Nonetheless, diagnostic models have tended to ignore some common sense reasoning exploited by human diagnosticians; In particular, one can learn from which observations have not been made, in the spirit of conversational implicature. There are two concepts that we describe to extract information from the observations not made. First, some symptoms, if present, are more likely to be reported before others. Second, most human diagnosticians and expert systems are economical in their data-gathering, searching first where they are more likely to find symptoms present. Thus, there is a desirable bias toward reporting symptoms that are present. We develop a simple model for these concepts that can significantly improve diagnostic inference.

Sequential Dirichlet Process Mixtures of Multivariate Skew t-distributions for Model-based Clustering of Flow Cytometry Data Machine Learning

Flow cytometry is a high-throughput technology used to quantify multiple surface and intracellular markers at the level of a single cell. This enables to identify cell sub-types, and to determine their relative proportions. Improvements of this technology allow to describe millions of individual cells from a blood sample using multiple markers. This results in high-dimensional datasets, whose manual analysis is highly time-consuming and poorly reproducible. While several methods have been developed to perform automatic recognition of cell populations, most of them treat and analyze each sample independently. However, in practice, individual samples are rarely independent (e.g. longitudinal studies). Here, we propose to use a Bayesian nonparametric approach with Dirichlet process mixture (DPM) of multivariate skew $t$-distributions to perform model based clustering of flow-cytometry data. DPM models directly estimate the number of cell populations from the data, avoiding model selection issues, and skew $t$-distributions provides robustness to outliers and non-elliptical shape of cell populations. To accommodate repeated measurements, we propose a sequential strategy relying on a parametric approximation of the posterior. We illustrate the good performance of our method on simulated data, on an experimental benchmark dataset, and on new longitudinal data from the DALIA-1 trial which evaluates a therapeutic vaccine against HIV. On the benchmark dataset, the sequential strategy outperforms all other methods evaluated, and similarly, leads to improved performance on the DALIA-1 data. We have made the method available for the community in the R package NPflow.

Dependent relevance determination for smooth and structured sparse regression Machine Learning

In many problem settings, parameter vectors are not merely sparse, but dependent in such a way that non-zero coefficients tend to cluster together. We refer to this form of dependency as "region sparsity". Classical sparse regression methods, such as the lasso and automatic relevance determination (ARD), which model parameters as independent a priori, and therefore do not exploit such dependencies. Here we introduce a hierarchical model for smooth, region-sparse weight vectors and tensors in a linear regression setting. Our approach represents a hierarchical extension of the relevance determination framework, where we add a transformed Gaussian process to model the dependencies between the prior variances of regression weights. We combine this with a structured model of the prior variances of Fourier coefficients, which eliminates unnecessary high frequencies. The resulting prior encourages weights to be region-sparse in two different bases simultaneously. We develop Laplace approximation and Monte Carlo Markov Chain (MCMC) sampling to provide efficient inference for the posterior. Furthermore, a two-stage convex relaxation of the Laplace approximation approach is also provided to relax the inevitable non-convexity during the optimization. We finally show substantial improvements over comparable methods for both simulated and real datasets from brain imaging.