Identity Resolution Daily

[Post from Infoglide] Is Government Committed to Solving Healthcare Fraud – Or Not?

“Last week Rep. Scott Murphy of Glen Falls (D-NY) told a House panel that more effective policing of Medicare and Medicaid fraud claims is imperative in order to reduce the estimated $60 billion in fraudulent claims that is disbursed each year. We agree with the expressed intent, and we are hopeful that CMS  and others involved in decision-making will take advantage of any and all technologies to stamp out fraud, including identity resolution.”

The Westside Story: In Case You Missed It: Houston Health Care Fraud Indictments in Texas Attorney General Joint Investigation

“The scheme to defraud is alleged to have begun in April 2004, through Logic World, with the last allegedly false claim having been filed in February 2010 through Roben Medical. During this time period, Essien and Akpan allegedly billed and caused the billing of Medicaid for claims totaling approximately $2,341,293.64 and received payments for those claims totaling approximately $1,455,837.91.”

IAIABC: Early Assessment of the Impacts of Federal Health Care Reform on Workers’ Compensation

“The Congressional Budget Office estimates electronic health records could save the U.S. $12 billion over 10 years, which seems very modest in comparison to the estimated $2.2 trillion spent on healthcare in the U.S in 2010. While workers’ compensation medical bill payers are not covered entities under HIPAA they will be required to have “business associate agreements” with HIPAA covered entities for the electronic exchange of patient health information. It remains to be seen how this will force workers’ compensation payers to modify their business practices.”

iContact Community: Identity Resolution Daily newsletter: June 18

“A recent video story on KING5 in Seattle highlighted the aggressive efforts state agencies take to ferret out employment fraud. This particular story highlights an agency’s success in identifying and prosecuting unlicensed contractors.”

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By the Infoglide Team

Homeland Security: Secretary Napolitano Announces Major Aviation Security Milestone

“Department of Homeland Security (DHS) Secretary Janet Napolitano today announced that 100 percent of passengers traveling within the United States and its territories are now being checked against terrorist watchlists through the Transportation Security Administration’s (TSA) Secure Flight program—a major step in fulfilling a key 9/11 Commission recommendation.”

NaplesNews: New Gulf Coast ‘fusion center’ creates 10-county law enforcement initiative

“The center, which is housed in the FBI’s Fort Myers office near Gateway, is designed to digest and compare data from across the region. Once complete, Storrar said the center will help local officials bridge jurisdictional, historical and technological barriers. It will help law enforcement, fire and health officials look for red flags, connect dots and provide threat assessments, Storrar said.”

WSJ: Loopholes Allow Tainted Money Into U.S., Report Says

“In the case of Teodoro Nguema Obiang Mangue, the son of the president of Equatorial Guinea, the report said two lawyers helped him bypass anti-money-laundering laws by allowing him to use shell company accounts as conduits for his funds without telling U.S. bankers that Obiang was using the accounts. ‘If a bank later uncovered Mr. Obiang’s use of an account and closed it, the lawyers helped him set up another,’ it said.”

California Healthline: California Organizations Nab $18.46M in Health IT Stimulus Funding

“Officials said health care providers at the centers who demonstrate ‘meaningful use’ of EHRs could be eligible for federal incentive payments through Medicaid and Medicare.”

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[Post from Infoglide] Customer Authentication and Identity Resolution

“The accepted meaning of ‘multi-factor authentication’ is employing at least two of the three standard factors used to authenticate identities:

1. something the user knows (e.g. , PIN or password)
2. something the user has (e.g., ATM or smart card)
3. something the user is (e.g., biometric such as fingerprint)

Building upon this well understood concept in the banking and financial services world, I’d like to describe how identity resolution technology extends and greatly enhances the value of authentication systems to the enterprise.”

LexisNexis Workers’ Compensation Law Community: NY: Owner of Manhattan Temp Agency Hit With $25M Comp Fraud

“Mr. Goldstein also failed to cooperate to allow NYSIF to audit the companies’ payrolls, wherein NYSIF would simply raise premium rates on the policies in effect. To avoid paying higher rates, Mr. Goldstein allowed NYSIF to cancel policies for non-payment, and repeated this pattern by allegedly obtaining other policies from NYSIF under false pretenses.”

CRMBuyer: The Big Business of Electronic Health Records, Part 2

“The federal EHR program authorized under the American Recovery and Reinvestment Act of 2009 consists of two parts. The first provides financial assistance through Medicare and Medicaid to healthcare providers who implement EHR systems. In the second phase, instead of receiving financial assistance, providers who fail to comply with EHR implementation requirements will be penalized by reductions in their Medicare or Medicaid reimbursements.”

Technology Review: TR10: Cloud Programming

“Today, many developers are converting existing programs to run on clouds, rather than creating new types of applications that could work nowhere else. And they are held back by difficulties in keeping track of data and getting reliable information about what’s going on across a cloud.”

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[Post from Infoglide] Trade-Based Money Laundering

“Who’d have thought that iTunes could be used for money laundering? Yet that is exactly what five men in Great Britain were recently jailed for the other day. Using stolen credit card numbers, they bought £750,000 in vouchers, then sold them at cheaper prices over eBay. Methods of money laundering continue to evolve.”

Liliendahl on Data Quality: Big Time ROI in Identity Resolution

“So the question is if authorities may have avoided losing 5 billion taxpayer Euros if some identity resolution including automated fuzzy connection checks and real world checks was implemented. I know that you are so much more enlightened on what could have been done when the scam is discovered, but I actually think that there may be a lot of other billions of Euros (Pounds, Dollars, Rupees) to avoid losing out there by making some decent identity resolution.”

LISTA: The Privacy and Security Challenges of Electronic and Personal Health Records: Is Your Business Prepared?

“In a 2008 study conducted by Kroll Fraud Solutions/HIMSS Analytics to better understand the status of patient data security at hospitals, the hospitals surveyed reported an average level of preparedness to deal with a security breach of 5.88 on a one to seven ascending scale.19  Yet the same study indicated that only 56 percent of these hospitals had notified patients whose information was compromised as a result of a security breach.”

Newsweek: Intel Paper Says Al Qaeda’s Yemeni Affiliate More Determined Than Ever to Attack Inside U.S.

“The ‘official use only’ bulletin, produced by the Northern California Regional Intelligence Center, a partnership of federal, state, and local agencies originally set up to deal with drug trafficking, is entitled ‘Al-Qa’ida in the Arabian Peninsula’s Online Rhetoric Signals Shift in Intentions.’”

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By the Infoglide Team

Media Health Leaders Media: Detroit Doc Gets Six Years for Medicare Fraud

“Myint, of Bloomfield Hills, MI, was also ordered to pay more than $3.1 million in restitution, jointly with co-defendants, and to serve two years of supervised release following his prison term. Terrence Hicks, of Jackson, MI, the patient recruiter, was ordered to pay more than $4.9 million in restitution, jointly with co-defendants, and to serve three years of supervised release following his prison term.”

AolTravel: Is the No-Fly List Working?

“‘The TSA is hoping to smooth glitches with the new Secure Flight program — a system by which the ‘TSA will conduct uniform prescreening of passenger information against federal government watchlists,’ according to an official statement. ‘The TSA is taking over this responsibility from the airlines.’ The TSA says the Secure Flight system will be in effect for all domestic flights by mid-2010 and all international flights by the end of 2010, at which time the latest two-hour notification rule will become moot (since the airlines will no longer be responsible). Meanwhile, in the case of Shahzad, Kahn says it’s important to remember that the current system — for all its perceived faults related to his near escape — ultimately did what it was meant to do.”

ITBusinessEdge: Baby Steps to Master Data Management

“If you want to start small with master data management, you’ve got to start with a noun, says Evan Levy, a partner at Baseline Consulting  and an instructor with The Data Warehousing Institute… The problem is, IT doesn’t think in nouns. IT is all about the verb: Defining, coding, testing, supporting. What’s more, IT departments tend to view the world in terms of projects – fulfilling this feature request, upgrading to this release, migrating to this server.”

Liliendahl on Data Quality: Aadhar (or Aadhaar)

“In Denmark we have had such an identifier (one for citizens and one for companies) for many years. It is not used by everyone everywhere – so you still are able to make money being a data quality professional specializing in data matching. The main reason that the unique citizen identifier is not used all over is of course privacy considerations.”

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By the Infoglide Team

The Miami Herald: Medicare’s fraud hot line begins to root out billing scams

“By September, Feliberto Ramos was arrested on fraud charges accusing him and his company, Miracle Group Rehabilitation Center, of falsely billing the federal healthcare program $3.1 million over just three months. Medicare paid Ramos $1.9 million for rehab services never provided to angry beneficiaries.”

OCDQ:Data, data everywhere, but where is data quality?

“Data matters because everything—and not just the rows in our relational databases and spreadsheets, but also our status updates from Facebook and Twitter, our blog posts, and even most of our daily conversations—is data. The growing challenge is can we extract meaningful insights from these vast and veritable oceans of unrelenting data volumes, and use those insights to make better decisions in near real-time in order to positively impact the various aspects of our lives.”

eBusiness Tweets: Microsoft entering the electronic medical record (EMR) software market

“You would think Microsoft would be in such a promising industry, but you won’t find a Microsoft EHR available. The primary reason why is that EHRs are highly specialized, and Microsoft’s main products (Dynamics, CRM, and SharePoint) don’t come anywhere near the needs of physician practices. It would be very difficult for Microsoft to build an EHR from scratch and introduce it to the market. so what should Microsoft do to enter the industry? Acquire a current player.”

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By the Infoglide Team

Liliendahl on Data Quality: What is a best-in-class match engine?

“I don’t think anyone knows what product is the best match engine, because I don’t think that all match engines have been benchmarked with a representative set of data.”

ITBusinessEdge: SOA Spending on the Rise. Surprised? Here’s Why

“It’s important to realize that SOA is really a rather loose collection of best practices. It’s not necessarily a well-defined list where you have some checklist of things to do SOA and if you miss one, you’re not doing SOA. What’s happening is architecture teams are incorporating SOA best practices into various other initiatives.”

BTNonline.com: TSA To Assume All Watchlist Matching For U.S. Carriers By June, All Carriers By January

“The U.S. Transportation Security Administration is on track to assume watchlist matching from all U.S. carriers by the end of May, only slightly behind its March 31 U.S. implementation target for the Secure Flight passenger prescreening system, according to a U.S. Government Accountability Office report. The Secure Flight program also calls for TSA to assume watchlist matching from foreign carriers, and the agency already is working with 19 airlines outside the United States to do so. Five of those carriers are fully functional within the program, and an additional 14 are testing, GAO reported.”

[video] KENS5.com: UT Health Science Center helps bring medicine into computer age

“Currently 80 to 90 percent of all medical records are stored on paper.  The goal is that have an electronic health record for everyone in the U.S. by 2014. Electronic health records are expected to greatly reduce the number of medical errors, which is significant.  Each year in the United States, as many as 100,000 people die in hospitals because of such errors.  That’s the equivalent of one major airline crash every single day of every single year.”

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By the Infoglide Team

Forrester Blog: TIBCO jumps onto MDM M&A train with acquisition of data matching vendor Netrics

[Rob Karel] “Netrics seemed the most likely target for Oracle to replace Identity Systems with its small footprint and relatively low acquisition cost, but now with Netrics off the market, Oracle should consider other matching vendors such as S3 Matching Technologies, Syslore or identity resolution/matching vendor Infoglide Software.”

msnbc: What is TSA’s Secure Flight Program?

“Secure Flight launched in August, is currently in a phase-in stage, and is intended to be fully in place by November 2010 for all flights leaving from and/or arriving in the U.S. Essentially, the airlines and booking engines will collect your full name, gender and birth date when you book your flight and send that info to the TSA, which will then compare the information against the no-fly list. The name you give when you book must synch up with your full name as shown on the government-issued ID you use when checking in for your flight.”

Michael Power: Can Governments Force Patient Data into EHRs?

“As a brief and somewhat simplistic aside, ‘electronic health record’ is a term often incorrectly used to describe both EHRs and EMRs. There is a distinction between the two and it is an important one. Hospitals and physicians use EMRs. EMRs, along with other databases, are expected to feed into a longitudinal ‘virtual’ patient record which is to be accessible across providers and institutions and which is properly referred to as the EHR.”

Security Management: Terror Threat Tracking System Shares Thousands of Tips from Locals, FBI Says

“The eGuardian system is one of the core technological elements of the Information Sharing Environment (ISE) established by congressional mandate in response to the intelligence failures that preceded the 9-11 attacks. In a typical scenario, a law enforcement agency will either generate its own SAR or field one from the public.”

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[Post from Infoglide] Garbage In, Garbage Out? Not Necessarily.

“One of the oldest phrases in computer science seems to still be in vogue. ‘Garbage in, garbage out’ (GIGO) is a term coined during the early days of the computing industry. It pointed out that the value of computer systems of the day were entirely dependent upon their input data. No amount of processing power could produce a right answer from bad data. Fast forward many decades…”

Formtek: Technology: Data Consistency via Master Data Management

“The concept of MDM is a good one, and many companies have piloted MDM projects over the last few years.  Now research firm Baseline Consulting  says that many companies are beginning to move beyond their MDM pilot systems.  Baseline Consulting co-founder Jill Dyche said that ‘the fact that data quality, data governance, and data enrichment processes may accompany an MDM initiative make it all the more attractive as an enterprise solution.’”

HSToday: DHS Intelligence Needs More Oversight

“The success of the fusion center program,” said the report, “ is dependent on the infrastructure that enables state and local fusion centers to have access to each other’s information as well as to the appropriate federal databases. The fusion center program and the Nationwide Suspicious Activity Report Initiative (NSI) rely on the concept of shared space architecture, where the fusion centers replicate data from their systems to an external server under their control, making the decision on what to share totally under their control.”

HealthITExchange: EHR implementation a foregone conclusion, ONC says

“No matter how the rules shake out, EHR implementation in the United States is a foregone conclusion, Blumenthal said. He sees the skills of collecting, using, searching and sharing health data electronically becoming part of the assumed professional skill set for health care providers, just as using a stethoscope is now. In the next five to 10 years, hospitals will use their robust EHR systems to recruit physicians; solo physicians who succeed in implementing EHR will sell their practices more easily when the time comes, but solo physicians still using paper will not be able to sell their practices at all.”

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[Post from Infoglide] Identity Resolution Still On the Rise

“We’ve noted several times over the past couple of years how the market visibility of entity resolution has been evolving. Now the consolidation of the master data management (MDM) market is causing even more conjecture about the crucial role of this technology.”

SIGNAL ONLINE: Good Guys Share, Bad Guys Lose

“Lindsey adds that personnel on Joint Terrorism Task Forces, in fusion centers or in other counterterrorism-related positions could benefit from the system by accessing the more complete data source and incorporating information found there into their own analyses and evaluations. ‘We’re out there for the crime fighters, but we’re also out there to prevent terrorism activities,’ he states.”

Claims Magazine: Fraud Triage Programs 

“The Federal Bureau of Investigation estimates that the total cost of insurance fraud (excluding health care) exceeds $40 billion per year. That means insurance fraud costs the average U.S. family between $400 and $700 annually in the form of increased premiums. In California alone, the Department of Insurance (CDOI) identified the potential loss from fraud in the 2007/2008 fiscal year at $1.2 billion, according to the 2008 Annual Report of the Insurance Commissioner.”

FoxNews.com: Flight Diverted to Florida Over Passenger’s Mistaken Identity

“Some airlines already have moved to a new identification program, called Secure Flight. All domestic carriers are expected to move to the new program by March. The government system will include more details about the passenger in question, including the passenger’s sex, birth date and full name as it appears on a government identification document.”

Precision Document Imaging: What is EMR?

“The American Recovery and Reinvestment Act of 2009 provides significant cash incentives to physicians who implement electronic health records. However, in order to qualify for these incentives the physician must not only have the proper software but must engage in “meaningful use” of the software. The government plans to publish the criteria for meaningful use in February 2010. ARRA incentive reimbursement to physicians will begin in 2011.”

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