Hierarchical Multi-Modal Fusion on Dynamic Heterogeneous Graph for Health Insurance Fraud Detection

Abstract

In this paper, we devote to aggregating longitudinal and multi-modal information from heterogeneous neighbors to obtain an accurate node embedding on the dynamic heterogeneous graph. Recently, Heterogeneous Graph Neural Networks (GNNs) have attracted extensive attention in fraud detection. However, when faced with longitudinal and multi-modal data such as health insurance records, existing GNN-based fraud detectors always discard the multi-modal information (e.g., medication and treatment) of heterogeneous neighbors and ignore the inconsistent claimer behavior in the longitudinal records. To fully utilize the information, we represent the records in the form of a dynamic heterogeneous graph, and propose Hierarchical Multi-modal Fusion Graph Neural Network (HMF-GNN) which learns not only topological information, but also embeddings of longitudinal and multi-modal entities to improve the performance of fraud detection. Experimental results on two real-world health insurance datasets demonstrate that HMF-GNN outperforms state-of-the-art graph embedding methods and GNN-based fraud detectors.