cs.AI updates on arXiv.org 10月16日 12:26
知识引导弱监督模型CleverCatch:医疗欺诈检测新突破
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本文提出了一种名为CleverCatch的知识引导弱监督模型,旨在提高医疗欺诈检测的准确性和可解释性。通过将结构化领域专业知识与神经网络结合,CleverCatch在模拟数据和实际数据上均取得了显著的效果。

arXiv:2510.13205v1 Announce Type: cross Abstract: Healthcare fraud detection remains a critical challenge due to limited availability of labeled data, constantly evolving fraud tactics, and the high dimensionality of medical records. Traditional supervised methods are challenged by extreme label scarcity, while purely unsupervised approaches often fail to capture clinically meaningful anomalies. In this work, we introduce CleverCatch, a knowledge-guided weak supervision model designed to detect fraudulent prescription behaviors with improved accuracy and interpretability. Our approach integrates structured domain expertise into a neural architecture that aligns rules and data samples within a shared embedding space. By training encoders jointly on synthetic data representing both compliance and violation, CleverCatch learns soft rule embeddings that generalize to complex, real-world datasets. This hybrid design enables data-driven learning to be enhanced by domain-informed constraints, bridging the gap between expert heuristics and machine learning. Experiments on the large-scale real-world dataset demonstrate that CleverCatch outperforms four state-of-the-art anomaly detection baselines, yielding average improvements of 1.3\% in AUC and 3.4\% in recall. Our ablation study further highlights the complementary role of expert rules, confirming the adaptability of the framework. The results suggest that embedding expert rules into the learning process not only improves detection accuracy but also increases transparency, offering an interpretable approach for high-stakes domains such as healthcare fraud detection.

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医疗欺诈检测 知识引导弱监督模型 CleverCatch 神经网络 领域专业知识
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