Identity Resolution Daily

[Post from Infoglide] New Record for Healthcare Fraud: $163 Million

“Last night the largest Medicare fraud operation yet discovered was in the headlines: ‘A vast network of Armenian gangsters and their associates used phantom health care clinics and other means to try to cheat Medicare out of $163 million, the largest fraud by one criminal enterprise in the program’s history, U.S. authorities said Wednesday. Federal prosecutors in New York and elsewhere charged 73 people.’”

Government Executive: Most domestic intel centers lack privacy plans

“After the Sept. 11, 2001, terrorist attacks, the U.S. government encouraged and funded a proliferation of domestic counterterrorism centers, commonly referred to as state and local homeland security fusion centers. Although 72 centers now exist, only 28 have privacy and civil liberties plans approved by the Homeland Security Department, National Journal has learned.”

marketwire: Cloud Computing Market to Reach $25 Billion by 2013

“Worldwide Cloud Computing market is continuing to grow at a rapid rate and it is expected to cross US$ 25 Billion by the end of 2013. The different segments of the Cloud Computing market (SaaS, PaaS, IaaS) show different maturities and adoption levels. The various segments within the SaaS market will grow at a different rate.”

TravelAgentCentral: Update: Secure Flight Rules Effective November 1

“Secure Flight watch list matching takes a matter of seconds to complete, and providing this data enables passengers to print their boarding passes at home or at an airline kiosk, TSA notes. The November 1 deadline marks the end of the year-long grace period for airlines to clear out their systems of older reservations made before Secure Flight requirements took effect in October 2009. After November 1, 2010, Secure Flight will not conduct watch list matching or approve the issuance of a boarding pass by an airline if complete passenger data is not submitted, the TSA says.”

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By the Infoglide Team

Kaiser Health News: Medical Loss Ratio Rule Should Encourage Health Care Fraud Fighting

“There is undoubtedly a direct connection between health care fraud and health care quality. Consider the Kansas physician convicted of health care fraud linked to the death of patient. He had been running a ‘pill mill’ in a small town, which led to more than 100 overdoses and at least 68 deaths. All the while, he submitted millions of dollars in false claims to government programs and private insurers.”

Miami Herald: Final phase of TSA’s Secure Flight program taking effect

“The information will be required on third-party online booking sites and with travel agents as well as directly through the airlines, according to TSA. David Castelveter, spokesman for the Air Transport Association, said airlines have updated their reservation systems as needed since TSA started requiring airlines to collect the data a year ago. He said compliance on the part of passengers is necessary for their ease of travel.”

Washington Independent: Combatting Homegrown Terrorism With Fusion Centers

“One of the ways DHS is approaching this threat is by beefing up the country’s network of fusion centers — groups that fuse local law enforcement work with national-level intelligence.”

backupify: The Economics of Cloud Computing

“Cloud computing became the hot topic of discussion when the recession hit and companies had to tighen up their budgets. They could no longer afford expensive servers, clunky software, and entire IT teams to manage this infrastructure. Cost constraints led decision makers to open their minds to cloud computing. At this time, cloud computing was a fairly new concept and term, which led to many raised eyebrows and question marks. However, as companies slowly adopted cloud services, many others began to understand its purpose and benefits.”

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[Post from Infoglide] Commercial Fusion Centers

“Several years ago, the Department of Homeland Security (DHS) published guidelines for creating fusion centers at the state, local, and federal levels. Since then, fusion centers have become a hot trend in the law enforcement community… If governmental agencies with common concerns can band together to create fusion centers, it seems possible that private companies with common goals could use technologies such as identity resolution to achieve them.”

Wisconsin Radio Network: Compliance check nets lottery liars

“According to a release (PDF)  from the office of Attorney General J.B. Van Hollen, 36 year-old Tyna Dull of Arena was charged in Iowa County Circuit Court, and 28 year-old Travis Ferguson of Gotham was charged in Richland County Circuit Court, each with one count each of Attempted Theft By Fraud. Dull and Fergison told Special Agent from the state Division of Criminal Investigation that the Lottery tickets presented by the agents as part of a Lottery compliance check, were not winning tickets.”

DBJ: Healthcare Quarterly: Hospitals’ road to EMRs costly

“Texas Health started installing its electronic medical records system four years ago and expects to spend more than $200 million by 2012 in capital and operating expenses to put the system in place, said Edward Marx, chief information officer. The hospital system expects to receive about $70 million in federal stimulus money over five years, beginning in early 2011, Velasco said. Patients are already experiencing the benefits of digitized records in Texas Health Resources hospitals, because the records are accessible to the appropriate care-giving team regardless of where the patient is moved in the hospital, Velasco said.”

NBCDFW: New Security Check Could Delay Air Travelers

 ”The program, called ‘Secure Flight,’ was first implemented in August 2009. The government has given airlines more than a year to comply. The names will be checked with a federal database of terrorism suspects. The TSA says the added information will prevent many passengers from being misidentified as a potential terrorist. ‘Worst case scenario, if the person doesn’t have this information, they’ll be redirected back to the ticket counter to provide the information so they can get the boarding pass,’ TSA spokesman Luis Casanova said.”

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By Kevin Moore, Infoglide Software Director of Fraud Solution Sales

Several years ago, the Department of Homeland Security (DHS) published guidelines for creating fusion centers at the state, local, and federal levels. Since then, fusion centers have become a hot trend in the law enforcement community.  At last count, there were 72 designated centers around the country that are recognized by DHS (and that number is probably low by now). If governmental agencies with common concerns can band together to create fusion centers, it seems possible that private companies with common goals could use technologies such as identity resolution to achieve them.

Do businesses share common problems that could be better addressed by creation of “private fusion centers”? I thought of a few in a short time, so there are likely many more. It turns out that one called LERPnet already exists within the retail community:

The Law Enforcement Retail Partnership Network (LERPnet) is a secure national database for the reporting of retail theft and serious incidents, which allows retailers to share information with each other and law enforcement. In response to an alarming rise in organized retail crime, the retail industry and the FBI have teamed up to launch LERPnet. With LERPnet, retailers and law enforcement will be able to fight back against illegal activity including organized retail crime, burglaries, robberies, counterfeiting, and online auction fraud.

The details are on the LERPnet web site. Clearly, it took a lot of effort to resolve some key issues before it was launched. Companies are understandably concerned about complying with privacy laws and want some assurance that they won’t assume liability should a breach occur. They also consider their customer information to be proprietary, so solutions need to share only data about suspected fraud cases while leaving good customer data unshared. In many cases, scores instead of data can be shared. The general principle is to leave data in place as much as possible and don’t share proprietary data with others.

The LERPnet example could be classified as a “quasi-private” system since the participants include law enforcement agencies. What about your industry? Are there ways that well-protected information sharing could enable your company to avoid “doing business with people that, if they had a full view of that person, they would never even let them in the door”?

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By the Infoglide Team

4RSS: Infoglide Launches Anti-Fraud Solution Suite

“To help organizations comply with privacy laws, the Anti-Fraud Solution Suite can be configured to return only the calculated probability of a match, instead of the actual data associated with that match, or can return only partial data depending on the authorization level and country of the end user. ‘Many companies don’t realize they already have the data to solve the puzzle,’ said Mike Betron, director of marketing. ‘They are doing business with people that, if they had a full view of that person, they would never even let them in the door. But their fraud operations are segmented, and their data is dispersed throughout the organization. One hand doesn’t know what the other is doing. One line of business is about to sign a customer that is committing fraud to another line of business. Major financial institutions are losing millions of dollars because they don’t have a clear picture of their customers, vendors, partners, and employees.’”

backupify: 8 Ways Cloud Computing Will Help Your Company Scale Faster

“Cloud computing, sometimes known as software-as-a-service (SaaS) is the driving force of the Web 2.0 revolution. Small businesses are faced with the challenge of growing fast while staying lean and efficient. Most are constrained by financials, leaving them high and dry if they don’t know how to scale with a limited budget. Thankfully for them, cloud computing brings them powerful benefits to grow with little to no capital outlay.”

Tennessee Opinion: We all share duty for security

“After the terrorist attacks on 9/11, a number of comprehensive reviews of why the attack happened and why we were not prepared were conducted. Deficiencies and gaps identified by the 9/11 Commission appointed by the president stressed the importance of state and local law enforcement in sharing information and intelligence relative to terrorist activity. As a result, the U.S. Department of Homeland Security and the U.S. Department of Justice encouraged states to develop fusion centers. A fusion center is a collaborative effort of two or more agencies that provide resources, expertise and information with the goal of maximizing the ability to detect, prevent, investigate and respond to criminal and terrorism activity.”

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By the Infoglide Team

Fire Chief: NIST Makes Push Toward Electronic Health Record Nationwide Network

“The National Institute of Standards and Technology (NIST) published a set of approved procedures used to test information-technology systems that work with electronic health records (EHRs), with an emphasis on building out a nationwide health information network for better patient care. The report was released earlier this year in draft form, and now the finalized testing procedures are available for use, said Bettijoyce Lide, program coordinator and senior advisor for NIST’s health IT section.”

Homeland Security: Remarks as Prepared by Secretary Napolitano to New York City First Responders

“By the end of this year, all 72 fusion centers should be able to analyze information and spot trends in order to effectively share timely intelligence – with local law enforcement, and with DHS, so the information can also be used by others within the Intelligence Community. To support this vision: we’re prioritizing fusion centers in our FY2011 grants, and looking for ways to support them through additional technology and personnel, including the deployment of highly-trained experts in critical infrastructure; we’re deploying experienced DHS analysts to every one of these centers – 64 at last count – and we won’t stop until we have them in every one; and we’re linking them together, and with DHS headquarters, through the classified Homeland Security Data Network.”

WRAL.com: Linden woman gets 10 years in prison for Medicaid fraud

“Prosecutors said Elliott filed bills for therapy sessions that never happened, employed non-licensed personnel and provided unwarranted therapy. Tricare, the military equivalent to Medicaid, lost $1.17 million in the scheme, while Medicaid lost $712, 548, authorities said.”

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[Post from Infoglide] International Privacy Compliance

“International companies, particularly those in the financial services markets, have long struggled to comply with the varying data privacy laws of the countries in which they operate.  Simple data analysis practices in one region of the world may or may not be acceptable in another, and the penalties of non-compliance can be harsh to say the least.  This leads to inefficiencies in areas such as AML, Compliance and Fraud Investigation.”

nj.com: Elizabeth doctor is charged with hiring phony physicians to bilk Medicaid

“Despite their alleged lack of medical licenses, authorities say, the trio treated thousands of disabled and low-income patients, helping Masood bilk at least $1.8 million from Medicaid, the federally funded health care program for the poor. ‘Unsuspecting patients were placed at risk through deceit and substandard medical care, while taxpayers were being defrauded of millions of dollars,’ said Michael B. Ward, head of the FBI’s Newark office.”

FierceGovernmentIT: More DHS components to receive Watchlist Service data from FBI

“The specific initial recipients of the new automated service were identified as the TSA’s Office of Transportation Threat Assessment and Credentialing; the TSA Secure Flight Program; CBP’s Passenger Systems Program Office for inclusion in the Traveler Enforcement Compliance System; and US-VISIT for inclusion into the DHS Automated Biometric Identification System (IDENT).”

East Valley Tribune: Authorities: Valleywide crime database nears reality

“‘There are so many databases out there, officers want to be able to get into one portal for information,” Romley said. “Technology capabilities have improved immensely over the years, the real future is in databases when it comes to helping solve crimes quicker. Everyone knows the value of having an intelligence sharing system. the meeting was a baby step, but a monumental step forward.’ One example Romley cited was the East Valley Gang and Criminal Fusion Center that consists of law enforcement agencies throughout the East Valley such as the Mesa, Tempe, Chandler, Gilbert and Scottsdale police departments sharing information through having all of their police reports in a database for investigative purposes.”

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By the Infoglide Team

OCDQ Blog: The Data-Decision Symphony

“Data is now everywhere.  Data is no longer just in the structured rows of our relational databases and spreadsheets.  Data is also in the unstructured streams of our Facebook and Twitter status updates, as well as our blog posts, our photos, and our videos. The challenge is can we somehow manage to listen for business insights among the endless cacophony of chaotic data volumes, and use those insights to enable better business decisions and deliver optimal business performance.”

SecurityInfoWatch.com: Welcome to the melting pot

“A Fusion Center is a terrorism prevention and response center program that began as a joint project between the DHS and the U.S. Department of Justice’s Office of Justice Program. It is designed to gather information from government and the private sectors to aid in safety and security. The Fusion Centers share information at the federal level between the CIA, FBI, DoJ, U.S. Military and state and local level governments, as well as Emergency Operations Centers in the event of a disaster. State and local police departments provide both space and resources for the majority of Fusion Centers. The analysts working there can be drawn from DHS, local police, or the private sector as in the case of Dallas.”

South Florida Business Journal: Clinic operator convicted in $2.3M fraud

“According to evidence presented during the two-week trial in Michigan, between about November 2006 and March 2007, the defendants submitted about $2.3 million in claims to Medicare for injection therapy services that were never provided and were not medically necessary. Medicare paid about $1.7 million.”

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By the Infoglide Team

Fraud Prevention: Medicare and Medicaid Fraud: US Healthcare Reform

“Earlier this year, a jury found Pfizer owed Wisconsin $9 million for violating the state Medicaid fraud law more than 1.4 million times by purposely overcharging the state for prescription drugs. The company faces potential fines from $140 million to $21 billion.”

Security Debrief: What is a Law Enforcement Fusion Center?

“Fusion centers that are doing strategic analysis are best positioned to prevent criminal acts. Trained intelligence analysts in these centers look at a local tip or Suspicious Activity Report (SAR) and then use advanced search tools across many databases simultaneously for indications that the tip could be part of a much bigger ‘iceberg’ hiding below the surface.”

ZDNet: Yankee Group: Infrastructure as a Service now a bona fide cloud strategy

“The survey of 400 enterprises finds ‘24 percent of large enterprises with cloud experience’ are already using IaaS, and an additional 37 percent expect to adopt IaaS during the next 24 months. ‘While adoption is still much slower than that of SaaS solutions, the market is gaining traction,’ says Yankee.”

Detroit Free Press: Tiny name differences on tickets not a worry

“Under its new ‘Secure Flight‘ process, the government compares airline passenger names, gender and birth dates with data on a terror watch list. However, a reservation or boarding pass that uses a middle initial instead of a full middle name, misses a hyphen, contains a tiny typo or leaves off the ‘Jr.’ designation should not cause a problem, according to the Transportation Security Administration.”

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[Post from Infoglide] Best Practices Just Got Better

“On the heels of the very successful Association of Certified Fraud Examiners (ACFE) conference last month comes an industry event which represents investigators of financial crimes and fraud.  The International Association of Financial Crimes Investigators (IAFCI) meets in Washington, DC next week  with an agenda that is chock full of sessions involving discussions of best practices for solving and preventing financial crimes.”

Insurance & Technology: Analytics Improving Insurers’ Claims Fraud Detection Efforts

“In a recent report, Light noted that the key to successful fraud mitigation with technology is applying a combination of several methods - including the typical red flag approach, predictive modeling, neural networks, profiling, claims databases and identity matching - to ‘maximize the identification of true positive fraudulent claims and of true negative fraudulent claims.’”

Paul Davis on Crime: Connecting the Dots at the Local Level: Centers Make Homeland Security a State, City, and Local Affair

“Robert Riegle from the Department of Homeland Security describes fusion centers as force multipliers. ‘They leverage financial resources and the expertise of numerous public safety partners to increase information awareness and help our law enforcement agencies more effectively protect our communities.’”

The Blog: Judy Schurke, Director, Department of Labor & Industries

“L&I works extensively with state and federal law enforcement, and other regulatory agencies to detect and prosecute individuals committing workers’ comp fraud, contractors failing to register with the state, and businesses that wrongly classify workers to cheat on insurance premiums. Some investigations lead to criminal prosecution. People tend to think fraud only involves workers cheating the workers’ comp system. But in reality, millions of dollars are lost when employers, medical providers and contractors commit fraud.”

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