Electronic fraud detection in the U.S. Medicaid Healthcare Program: lessons learned from other industries

It is estimated that between $600 and$850 billion annually is lost to fraud, waste, and abuse in the US healthcare system,with $125 to$175 billion of this due to fraudulent activity (Kelley 2009). Medicaid, a state-run, federally-matchedgovernment program which accounts for roughly one-quarter of all healthcare expenses in the US, has been particularlysusceptible targets for fraud in recent years. With escalating overall healthcare costs, payers, especially government-runprograms, must seek savings throughout the system to maintain reasonable quality of care standards. As such, the need foreffective fraud detection and prevention is critical. Electronic fraud detection systems are widely used in the insurance,telecommunications, and financial sectors. What lessons can be learned from these efforts and applied to improve frauddetection in the Medicaid health care program? In this paper, we conduct a systematic literature study to analyze theapplicability of existing electronic fraud detection techniques in similar industries to the US Medicaid program

Unattended network operations technology assessment study. Technical support for defining advanced satellite systems concepts

The results are summarized of an unattended network operations technology assessment study for the Space Exploration Initiative (SEI). The scope of the work included: (1) identified possible enhancements due to the proposed Mars communications network; (2) identified network operations on Mars; (3) performed a technology assessment of possible supporting technologies based on current and future approaches to network operations; and (4) developed a plan for the testing and development of these technologies. The most important results obtained are as follows: (1) addition of a third Mars Relay Satellite (MRS) and MRS cross link capabilities will enhance the network's fault tolerance capabilities through improved connectivity; (2) network functions can be divided into the six basic ISO network functional groups; (3) distributed artificial intelligence technologies will augment more traditional network management technologies to form the technological infrastructure of a virtually unattended network; and (4) a great effort is required to bring the current network technology levels for manned space communications up to the level needed for an automated fault tolerance Mars communications network

Process Framework for Subscriber Management and Retention in Nigerian Telecommunication Industry

in the global telecommunication industry. Hence, a dominant approach for subscriber management and retention is churn control, since it is cheaper to retain an existing subscriber than acquiring a new one. Predictive modeling employs the use of data mining techniques to identify patterns and provide a result that a group of subscribers are likely to churn in the near future. However, the effectiveness of subscriber retention strategy in an organization can be further boosted if the reason for churn and the timing of churn can also be predicted. In this paper, we propose a data mining process framework that can be used to predict churn, determine when a subscriber is likely to churn, provides the reason why a subscriber may churn, and recommend appropriate intervention strategy for customer retention using a combination of statistical and machine learning techniques. This experiment is carried out using data from a major telecom operator in Nigeria

AI Solutions for MDS: Artificial Intelligence Techniques for Misuse Detection and Localisation in Telecommunication Environments

This report considers the application of Articial Intelligence (AI) techniques to the problem of misuse detection and misuse localisation within telecommunications environments. A broad survey of techniques is provided, that covers inter alia rule based systems, model-based systems, case based reasoning, pattern matching, clustering and feature extraction, articial neural networks, genetic algorithms, arti cial immune systems, agent based systems, data mining and a variety of hybrid approaches. The report then considers the central issue of event correlation, that is at the heart of many misuse detection and localisation systems. The notion of being able to infer misuse by the correlation of individual temporally distributed events within a multiple data stream environment is explored, and a range of techniques, covering model based approaches, `programmed' AI and machine learning paradigms. It is found that, in general, correlation is best achieved via rule based approaches, but that these suffer from a number of drawbacks, such as the difculty of developing and maintaining an appropriate knowledge base, and the lack of ability to generalise from known misuses to new unseen misuses. Two distinct approaches are evident. One attempts to encode knowledge of known misuses, typically within rules, and use this to screen events. This approach cannot generally detect misuses for which it has not been programmed, i.e. it is prone to issuing false negatives. The other attempts to `learn' the features of event patterns that constitute normal behaviour, and, by observing patterns that do not match expected behaviour, detect when a misuse has occurred. This approach is prone to issuing false positives, i.e. inferring misuse from innocent patterns of behaviour that the system was not trained to recognise. Contemporary approaches are seen to favour hybridisation, often combining detection or localisation mechanisms for both abnormal and normal behaviour, the former to capture known cases of misuse, the latter to capture unknown cases. In some systems, these mechanisms even work together to update each other to increase detection rates and lower false positive rates. It is concluded that hybridisation offers the most promising future direction, but that a rule or state based component is likely to remain, being the most natural approach to the correlation of complex events. The challenge, then, is to mitigate the weaknesses of canonical programmed systems such that learning, generalisation and adaptation are more readily facilitated

SwarMAV: A Swarm of Miniature Aerial Vehicles

As the MAV (Micro or Miniature Aerial Vehicles) field matures, we expect to see that the platform's degree of autonomy, the information exchange, and the coordination with other manned and unmanned actors, will become at least as crucial as its aerodynamic design. The project described in this paper explores some aspects of a particularly exciting possible avenue of development: an autonomous swarm of MAVs which exploits its inherent reliability (through redundancy), and its ability to exchange information among the members, in order to cope with a dynamically changing environment and achieve its mission. We describe the successful realization of a prototype experimental platform weighing only 75g, and outline a strategy for the automatic design of a suitable controller

An Overview on Application of Machine Learning Techniques in Optical Networks

Today's telecommunication networks have become sources of enormous amounts of widely heterogeneous data. This information can be retrieved from network traffic traces, network alarms, signal quality indicators, users' behavioral data, etc. Advanced mathematical tools are required to extract meaningful information from these data and take decisions pertaining to the proper functioning of the networks from the network-generated data. Among these mathematical tools, Machine Learning (ML) is regarded as one of the most promising methodological approaches to perform network-data analysis and enable automated network self-configuration and fault management. The adoption of ML techniques in the field of optical communication networks is motivated by the unprecedented growth of network complexity faced by optical networks in the last few years. Such complexity increase is due to the introduction of a huge number of adjustable and interdependent system parameters (e.g., routing configurations, modulation format, symbol rate, coding schemes, etc.) that are enabled by the usage of coherent transmission/reception technologies, advanced digital signal processing and compensation of nonlinear effects in optical fiber propagation. In this paper we provide an overview of the application of ML to optical communications and networking. We classify and survey relevant literature dealing with the topic, and we also provide an introductory tutorial on ML for researchers and practitioners interested in this field. Although a good number of research papers have recently appeared, the application of ML to optical networks is still in its infancy: to stimulate further work in this area, we conclude the paper proposing new possible research directions

Machine Learning in Wireless Sensor Networks: Algorithms, Strategies, and Applications

Wireless sensor networks monitor dynamic environments that change rapidly over time. This dynamic behavior is either caused by external factors or initiated by the system designers themselves. To adapt to such conditions, sensor networks often adopt machine learning techniques to eliminate the need for unnecessary redesign. Machine learning also inspires many practical solutions that maximize resource utilization and prolong the lifespan of the network. In this paper, we present an extensive literature review over the period 2002-2013 of machine learning methods that were used to address common issues in wireless sensor networks (WSNs). The advantages and disadvantages of each proposed algorithm are evaluated against the corresponding problem. We also provide a comparative guide to aid WSN designers in developing suitable machine learning solutions for their specific application challenges.Comment: Accepted for publication in IEEE Communications Surveys and Tutorial