一个强大且可解释的集体机器学习模型,用于预测医疗保险欺诈行为
Zeyu Wang1, Xiaofang Chen2, Yiwei Wu1
1School of Informatics, Xiamen University, Xiamen, 361005, Fujian, China.
这项研究通过机器学习提高了医疗保险欺诈检测. 通过优化功能和采用组合方法,它显著提高了准确性和模型可解释性,以获得更好的财务保护.
科学领域:
- 计算机科学 计算机科学
- 医疗保健管理健康管理
- 数据科学数据科学数据科学
背景情况:
- 医疗保险欺诈每年导致全球数十亿美元的损失.
- 准确的欺诈检测对于医疗保健的财务可持续性至关重要.
- 现有的方法往往缺乏可解释性和最佳特征选择.
研究的目的:
- 为了提高医疗保险欺诈检测的准确性.
- 提高用于欺诈检测的机器学习模型的可解释性.
- 为了确定最佳的特征子集,以实现高效的模型性能.
主要方法:
- 使用嵌入式和排列方法进行数据预处理和特征选择.
- 组合技术的应用 (投票,权重,堆叠) 用于模型聚合.
- 使用部分依赖图 (PDP),SHAP和LIME进行特征解释.
主要成果:
- 识别最小的特征集,实现高欺诈检测性能.
- 通过整体机器学习方法来证明提高准确性.
- 成功解释特征的重要性和对预测的影响.
结论:
- 机器学习,特别是组合方法,提供了一种有效的方法来打击医疗保险欺诈.
- 功能选择和解释是开发强大和易于理解的欺诈检测系统的关键.
- 这项研究为医疗保健中更准确,更易于解释的欺诈检测提供了框架.
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