“According to the Centers for Medicare and Medicaid Services, the program made nearly $24 billion in improper payments in 2009, almost doubling the previous years’ rate. The price of fraud, however, runs even higher. A CBS report notes that Medicare fraud costs taxpayers an estimated $60 billion a year, and some estimates put the figure at nearly $100 billion.”
“For the last two years, respondents to our survey have cited several information management-related problems among the top barriers to adopting BI tools company-wide. Data quality problems are cited most often, by 55% in both 2009 and this year, followed by ease-of-use challenges, and integration and compatibility with existing platforms. Among the people directly responsible for information management, the biggest impediments to success are accessing relevant, timely, reliable data (59%); cleansing, deduping, and ensuring consistent data (51%); and integrating data (49%).”
“Billions of your tax dollars are lost every year to healthcare fraud. In fact, the tab is $36Million a day for Medicare fraud alone. U.S. Congressman Michael Burgess of Lewisville watched FOX 4’s undercover investigation in to the practices of a home health care recruiter. Today, FOX 4’s Becky Oliver spoke with Congressman Burgess.”
“In just the last fiscal year, we obtained settlements and judgments of more than $2.5 billion in False Claims Act matters alleging health care fraud. This marked a new record – and an increase of more than 60 percent from fiscal year 2009. We also opened more than 2,000 new criminal and civil health-care fraud investigations, reached an all-time high in the number of health-care fraud defendants charged, stopped numerous large-scale fraud schemes in their tracks, and returned more than $2.5 billion to the Medicare Trust Fund and more than $800 million to cash-strapped state Medicaid programs.”
“Gartner reports that due to the sluggish economy, customer demand for MDM software is growing at a significantly slower rate than years past. But it is growing. The analyst firm predicts that the overall market for MDM software will increase from $1 billion in 2008 to $2.9 billion by 2013. Gartner also predicts that by 2010, investments in MDM software will lead to an 80% reduction in costs associated with managing redundant data.”
“Some of the nation’s 72 fusion centers–where federal, state, and local law enforcement agencies share data on terrorism and crime threats–may face budget problems in the nation’s tough economic conditions. Ross Ashley of the National Fusion Center Association, which represents the centers, says that some newly elected governors must be convinced of the centers’ worth. The agencies typically do not have line-item budgets and are dependent on allocations from various levels of government to operate.”
“This is the third in a series of four posts that discuss four methods for linking references. These methods are:
Direct matching
Transitive linking
Linking by association
Asserted Linking
In the last post I discussed transitive linking, and why it is essential for producing a unique and deterministic outcome of an ER process. In this post I will discuss the third method, linking by association.”
“There are many types of relationships that are discovered as a by-product of entity resolution, such as households or families. These terms take on different meaning depending on the subject area and the business situation. For example, we can examine parent-child and sibling relationships associated with individuals, we can look at components such as paper clips or screws that are in the same ‘family,’ or we can look at corporate ownership relationships that reflect families of companies. Alternatively, we can look at other types of relationships – individuals belonging to the same health club, components manufactured from the same type of metal, or companies that share the same board members.”
“In an 80-page civil complaint, the United States Attorney’s Office claims 51-year-old Doctor Robert Ritchea, a physician, not only allowed an unlicensed medical assistant to inject patients with pain medications, but also improperly billed Medicare for the treatments. The complaint also alleges Ritchea over-billed Medicare by more than $2.2 million in over 4,300 separate claims over a period of four years.”
“If you know that 123 Main Street in Anytown is a single family house there is a high probability that this is the same real world individual. But if you know that 123 Main Street in Anytown is a building used as a nursing home, a campus or that this entrance has many apartments or other kind of units, then it is not so certain that these records represents the same real world individual (not at least if the name is John Smith). So this example highlights the importance of using external reference data in data matching.”
“Ultimately, the defendant admitted making numerous deposits of less than $10,000 each to avoid triggering bank filing of the Currency Transaction Reports (CTRs) required for all activity involving five figures or more. In a single month, he made nearly 30 such deposits at a number of banks, totaling more than $260,000. Later, in almost 20 transactions at various branches of a single bank, he deposited an additional $185,000. That bank promptly filed a SAR detailing how the mortgage broker had deposited into his personal and business accounts sums ranging from $9,000 to $9,800.”
“The development of fusion centers has faced some significant challenges. First and foremost, the centers must overcome the practical challenge of integrating data. Even in the same state, you can have 500 police departments using different software to manage their [computer-aided design] and intelligence needs,” Serrao said. And generally that data is saved in different formats.”
“However, as the thought processes for establishing a business case for MDM mature, we are starting to see where the desire for the unified view is not completely dependent on an instantiation of a single consolidated repository. Instead, in these situations the business needs are supported by the availability of master data services implementing consistent information policies across an extended enterprise… the consistent application of policies can be done both in the presence of a unified repository or as a federated collection of common repositories!”
“As part of the scheme, Minnis allegedly forged and caused others to forge physicians’ signatures on various documents falsely representing that services, treatment, physical therapy and/or testing had been provided, ordered or supervised by medical doctors. Minnis allegedly forged the doctors’ signatures, and caused them to sign reports without having done patient exams, knowing that Workers’ Comp would not accept a chiropractor’s opinions or reports as medical evidence to support patients’ claims.”
“A recent post on McClatchy’s blog attributes growing insurance fraud to the recession: A recent survey of 37 state insurance-fraud bureaus by the Coalition Against Insurance Fraud found that the recession “appears to have had a significant impact on the incidence of fraud” last year. On average, the bureaus reported increases in case referrals and new investigations in all 15 categories of fraud the survey covers.”
“If we look at what data quality tools today actually do, they in fact mostly support you with automation of data profiling and data matching, which is probably only some of the data quality challenges you have.”
“Scott Stewart, vice president of tactical intelligence for Austin, Texas-based analysis firm Stratfor, says the killings might have been related to a recently announced U.S. plan to increase cooperation with Mexican law enforcement agencies. ‘We believe that it is likely related to a decision last month to start working more closely with the Mexican government by the Americans,” said Scott Stewart. “They were going to put some personnel into a joint fusion center in Juarez.’”
“The Coalition issued a statement supporting the bill, saying it would serve as a deterrent and a powerful incentive for medical providers to have strong compliance programs and to “play by the rules.” False claims acts help detect fraudulent schemes that otherwise might not ever be known because they allow insiders to blow the whistle and initiate civil actions.”
“Until now, Informatica’s MDM strategy has largely been peripheral. It had most of the tools (e.g., data integration, data quality, data profiling, and identity resolution) but tended to partner with bigger or best-of-breed players to promote MDM-oriented offerings or services… What’s risky about the acquisition of Siperian is that it imperils Informatica’s existing MDM partnerships (especially with Oracle Corp.) and compromises its neutrality pitch.”
“Fusion centers will conduct self-assessments, followed by a gap analysis and peer reviews, according to officials at the National Fusion Center Association, a new not-for-profit organization based in Alexandria, Va., that represents the 72 fusion centers. The assessments are meant to determine their progress in reaching baseline capabilities. Those capabilities were created by a federal advisory committee that also wrote the original guidelines for those centers.”
“Recent significant cases resulting in millions of dollars in savings to NYSIF have included claimants who receive benefits while operating businesses or remain employed in other capacities, the most prevalent type of workers’ comp. fraud. Other cases involve premium fraud, the most costly type, in construction, asbestos abatement and other contracting, including investigations in conjunction with the U.S. Department of Labor, the U.S. Postal Inspector, and local labor racketeering bureaus. Still other cases involve fraudulent provider billing.”
“The DHS has also tested mobile identification systems and created an information sharing plan with the Department of Justice which allows officials to search for criminal records. Art Macius, chief of staff at the Transportation Security Administration (TSA) added that organizations such as his and the DHS must also share information with their international counterparts. This international cooperation includes efforts such as cargo screening for commercial aircraft though efforts such as the Secure Flight program. Macius said that by this spring, the program will work with U.S. airlines to screen baggage and air cargo, and that the coverage will extend to international carriers by the end of the year.”
Andrew White of Gartner recently posed a question about whether master data management (MDM) is dead. He didn’t actually suggest that the demise of master data management is imminent. He was challenging whether our current terminology adequately clarifies the current reality about MDM and associated product areas.
Certainly the terms describing many markets and types of products are being associated with MDM. Jackie Roberts of DATAForge pointed out that the definition of MDM now seems to include “data integrity, data quality, entity resolution, matching, data integration, governance, metrics and analysis.”
While entity resolution was mentioned in her list, our obsessive focus on entity resolution (aka identity resolution) leads to the conclusion that, rather than being subsumed, its role is growing. Wayne Eckerson at TDWI seems to agree that identity resolution is a critical component of the recent MDM acquisitions. In his post about the acquisitions by Informatica and IBM of Siperian and Initiate Systems, respectively, he described the two transactions this way:
“You could say that Siperian is mostly MDM, but with identity resolution and other capabilities, whereas Initiate is mostly about identity resolution, but with MDM and other capabilities.”
Identity resolution is becoming an integral part of many product areas. Within MDM itself, creating a single-entity view is best done with an identity resolution engine. Data mining is greatly enhanced by the addition of entity resolution. Dan Power of Hub Solution Designs wrote about how key identity resolution is to data matching. We’ve talked about how social CRM can resolve identities of individuals across multiple disparate data sources using identity resolution, as well as “rationalize multiple variations and errors and anomalies that block finding existing customers within their systems”.
Although identity resolution technology has been years in the making, it has only recently risen into the consciousness of most analysts and customers. Because of its ability to bring enhanced clarity to ambiguous data, advanced identity resolution is now beginning to have a significant impact across many data-centered disciplines.
[Philip Howard] “To begin with, the company talked about its acquisition of Siperian. I have already commented on this but one point that emerged at the conference was the way that Informatica describes Siperian as infrastructure MDM as opposed to application MDM. This is a hitherto unrecognised distinction (with respect to terminology) in the MDM market. Informatica distinguishes the former from the latter by saying that infrastructure MDM is domain and data model independent.”
“Investigators alleged that the pair purchased thousands of workers’ compensation client referrals from an attorney television advertising service. Clients were then sent to doctors who had a relationship with Premier, which would handle billing and collection work in return for a 50 percent fee for money they collected. Clients were then sent to attorneys who had a business relationship with Fish and Bacino, investigators allege. ‘Getting kickbacks for referring medical payments is illegal and drives up the costs in the system,’ California Insurance Commissioner Steve Poizner said in a statement.”
“The MPD also established a fusion center, which is responsible for the national capitol region. From a homeland security perspective, Chief Lanier said that the center collects and stores crime and terror alerts into a data warehouse.”
“The fraudulent claims that can be made through insurance companies are categorized as being soft or hard. Soft fraud is the most common type of fraud and usually takes place when someone exaggerates a claim being made. Hard fraud takes place when someone deliberately plans a deceptive act such as a collision or the theft of their vehicle.”
“IBM owes it to its customers to explain if, when and how it plans to rationalize and integrate the overlapping MDM and data quality technology, said Ivan Chong, executive vice-president of the Redwood City, Calif.-based company’s data quality product division. ‘If I were them, I would have the impression that IBM is repurposing the technology for something completely different,’ said Chong.”
“Of the more than 300 law enforcement agencies in Florida, 105 — including the Lee and Charlotte county sheriffs’ offices — are currently sharing information on FINDER. Another 41 are currently utilizing the database, but aren’t sharing information. ‘The more departments we can get involved, the better,’ Weschler said. In the coming months, the Southwest Florida regional fusion center is slated to be operational. As an information hub, the center will gather, digest and compare data from across 10 Southwest Florida counties and 72 other fusion centers in the United States.”
“But as Abbasi and his team at Informatica continue to grow faster than most software companies, and as CIOs continue to realize how valuable Informatica’s data-integration and data-quality tools can be, and as it grows and expands into new areas such as MDM via its Siperian acquisition, Informatica’s value to those big software companies is soaring.”
“‘It’s just a blatant attempt to obtain benefits and money,’ Cosson said. ‘If someone files a false claim or is working while receiving benefits, ultimately that results in a loss of revenue for the insurance company and if they lose revenues, they have to raise rates and then the premiums clearly go up for legitimate businesses all over Colorado.’ The Coalition Against Insurance Fraud says that all insurance fraud costs every family $1,000 a year in higher premiums and it makes goods and services more expensive.”
“I read with interest yesterday’s article at SeekingAlpha which discusses rumors swirling around the MDM software industry. According to the article, sources suggest that two deals are very near completion. The first of those rumored transactions would see Informatica picking up MDM provider Siperian. On the heels of their acquisitions of Identity Systems and AddressDoctor, the Siperian purchase could not be totally unexpected – but would most certainly create some ripple effect worth watching.”
“Paul Rosenzweig, former Deputy Assistant Secretary for Policy at the Department of Homeland Security, recently posted an intriguing piece on Harvard National Security Journal about connecting the dots regarding the Christmas Bomber. He makes a strong case that a decision to stop research on data analytic tools in 2003 has contributed to the problem analysts face today in making sense of the massive and manifold data sources they sift through.”
“In the short term, I’m sure Informatica will be more than happy to continue to collect revenue from Oracle while keeping this partnership alive, but don’t expect future negotiated contracted terms to remain very reasonable as Informatica gains traction with its MDM strategy. No matter how often Oracle says how happy they are to maintain a friendly state of co-opetition with strategic partners, I don’t anticipate they will want to run the risk of a competitor pulling the rug out from under its aggressive MDM strategy.”
“According to department officials, sharing information with neighboring jurisdictions as well as state and federal agencies ensures that crime history and other information is shared outside the city limits. The department said it the center will be one that ‘analyzes information in order to best detect, respond and hopefully prevent criminal and terrorist activity — as well as other public safety hazards.’”
“As expected, Informatica has announced that it has acquired Siperian (disclosure, my former company) for $130M… If predictions are correct, this will be a relative ‘bargain’ when compared with the upcoming IBM and Initiate Systems tie up which is expected to be 4 to 5x Initiate’s $90M annual revenues.”
Infoglide Software provides entity resolution and analysis solutions for retail, banking, insurance, government, and law enforcement. Without the need for data cleansing or warehousing, Infoglide Software's Identity Resolution Engine™ (IRE) analyzes all of the information relating to individuals and/or entities from multiple sources of data and then applies...
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