Identity Resolution Daily

[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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[Post from Infoglide] Privacy – A Dying Concept?

“An intriguing post by Nate Anderson on Ars Technica highlights a difficult reality about today’s easy availability of vast quantities of ‘anonymized’ data. Quoting from a recent paper by Paul Ohm at the University of Colorado Law School, Anderson writes that ‘as Ohm notes, this illustrates a central reality of data collection: data can either be useful or perfectly anonymous but never both.’”

ComputerworldUK: Data quality tools sub-par, says analyst

“A recent study on data quality by the Information Difference revealed that respondents view data quality as something that is not restricted to one area within the organisation. Instead, two-thirds of respondents said it is an issue spanning the entire organisation…Specifically, 81 per cent of respondents reported being focused on a broader scope than merely customer name and address data.”

BeyeNETWORK: Master Data Management and the Challenge of Reality

“One of the central problems of master data management, which is often poorly stated, is the need to determine if one individual thing is the same as another individual thing. But the only way we have to do this is by matching records, and a record is not the same as the thing it represents. Unlike The Matrix, we are more in danger of confounding two ‘realities’ rather than recognizing them as distinct.”

Information Management: Business Intelligence: A Blueprint to Success

“Fraud detection. Claims managers are using predictive analytics to help identify potentially fraudulent claims as early as the first notice of loss, and are analyzing claims costs to get a better handle on negative trends.”

Government Computer News: How entity resolution can help agencies connect the dots in investigations

“Imagine a law-enforcement scenario. A local police department has information on a crime suspect. Court systems, corrections facilities, the department of motor vehicles and even child-support enforcement may also have information on this person of interest, each specific to its own needs and applications. Implementation of an entity-centric environment would enable each of the organizations and systems to continue its operations while also providing the police a much more holistic view of the crime suspect along with potentially important pieces of information.”

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By the Infoglide Team

[Post from Infoglide] Social CRM, CDI, and Identity Resolution

“In her well-read book on CDI, Jill Dyché offers a definition of CDI that also seems to describe social CRM. Try reading her definition of CDI, replacing ‘CDI’ with ’social CRM’:  CDI is a set of procedures, controls, skills and automation that standardize and integrate customer data originating from multiple sources(1).”

Charleston Daily Mail: Former owner of WVa trucking company sentenced

“Leonard Cline formerly owned H & H Trucking. The insurance commissioner says he defrauded the old state workers’ compensation system of more than $500,000 in unpaid premiums, penalties and claims for benefits over about 10 years.”

WTVQ: Eight People Indicted for Insurance Fraud

“The US attorney’s office says the suspects intentionally damaged insured automobiles owned by other conspirators then filed claims.”

KansasCity.com: Push for electronic medical records picks up steam

“With or without health care reform this year, electronic medical records are picking up steam. Recent technological advances are easing the transition for doctors and hospitals, and there’s the little matter of the Health Information Technology for Economic and Clinical Health Act. The act, part of last spring’s stimulus package, included billions of dollars to ‘advance the use of health information technology.’ There’s plenty of advancing to do, with one group estimating that less than half the hospitals and only one in five physicians are equipped to fully use electronic records. ‘The United States is far more advanced in grocery store technology than in medical records technology,’ said Steve Lieber, president and chief executive officer of the Healthcare Information and Management Systems Society in Chicago.”

pnj.com: Man charged with workers’ comp fraud

“Florida Chief Financial Officer Alex Sink announced the arrest today in a news release. In the release, Sink said her Division of Insurance Fraud said Soto is charged with falsifying employment numbers with the intent of avoiding higher workers’ compensation premium payments.”

Federal News Radio: Update: Identity management in the Obama administration

“The alphabet soup of identity management programs from the Bush administration — HSPD-12, TWIC, Real ID, and many more — have gotten little attention publicly during the first nine months of the Obama presidency. But that doesn’t mean identity management has been ignored totally, says one senior administration official.”

London Evening Standard: Lloyd’s chief warns of more insurance fraud

“Lloyd’s of London’s chief executive Richard Ward today warned the deep recession would increase the number of fraudulent claims being made against the insurance market.”

Computerworld: Laptop searches at airports infrequent, DHS privacy report says

“The U.S. Department of Homeland Security’s annual privacy report card revealed more details on the agency’s  controversial policy involving searches of electronic devices at U.S. borders. . . . For instance, numbers released in the report indicate that warrantless searches of electronic devices at U.S. borders are occurring less frequently than some privacy and civil rights advocates might have feared. Of the more than 144 million travelers that arrived at U.S. ports of entry between Oct. 1, 2008 and May 5, 2009, searches of electronic media were conducted on 1,947 of them, the DHS said.Of this number, 696 searches were performed on laptop computers, the DHS said. Even here, not all of the laptops received an ‘in-depth’ search of the device, the report states. A search sometimes may have been as simple as turning on a device to ensure that it was what it purported to be. U.S. Customs and Border Protection agents conducted ‘in-depth’ searches on 40 laptops, but the report did not describe what an in-depth search entailed. . . . The report chronicled similar efforts to monitor the privacy implications of a range of projects that privacy groups are also watching. Examples include  Einstein 2.0 network monitoring technology that improves the ability of federal agencies to detect and respond to threats, and the  Real ID identity credentialing program. The DHS’s terror watch list program, its numerous  data mining projects  and the secure flight initiative were also mentioned in the report.”

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By the Infoglide Team

MAINJUSTICE: Report Finds Flaws in DOJ Worker Comp Oversight

[easy registration required] “The Justice Department does not have effective measures in place to prevent fraud, abuse and waste in its program to provide compensation for employees with work-related injuries or illnesses, according to a DOJ Office of Inspector General report released today.”

Information Management: HP and Informatica’s Expanded Relationship: Portent of Bigger Deals to Come?

“So is the partnership with Informatica a ‘proof of concept’ for future acquisition or is it simply HP BIS’s answer: ‘We are a services business and we will leave software to our partners’?”

FederalComputerWeek: 5 decisions that will determine the fate of e-health records

“Under the economic stimulus law passed earlier this year, as much as $45 billion will be distributed to health care providers who buy and use approved electronic health record systems. The road ahead is still bumpy for EHRs, but experts say success hinges on the outcomes of five major decisions.”

Dalton’s Blog: Migrating Data into an MDM Repository - Case Study

“Notice that if you’re using Data Federation to implement your MDM solution, there is no data migration. Data Federation acts as a virtual central repository, and as such, does not require a physical copy of your source data. Data Federation “translates” the source information in real time according to required business rules and definitions. It is, so to speak, a real-time Extract-Transform process.”

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[Post from Infoglide] False Positives versus Citizen Profiles

“A post from Steve Bennett in Australia refers to an announcement by the Dutch government about their intent to prevent crime by profiling their citizens. By creating a digital profile of each citizen using banking, flight, and internet usage information, their justice department plans to compare citizen profiles with those of convicted criminals, then let law enforcement authorities know when matches are found. Needless to day, the move has created quite a bit of discussion in the Netherlands.”

MAINJUSTICE: Rival Agencies Agree to Halt Turf Battles

[quick registration] “‘By bringing together the agencies and personnel with existing resources and expertise we can work more effectively as partners to shut down organized crime networks, seize assets and save taxpayer dollars in the process,’ said Deputy Attorney General David Ogden in [a] statement announcing the partnership.”

HealthData Management: Assessing Demand for EHRs

“On Aug. 20, David Blumenthal, M.D., national coordinator for health information technology, predicted that the final definition of the “meaningful use” of electronic health records that will be used to determine eligibility for incentive payments under the economic stimulus program will not be available until the middle or end of spring 2010.”

South Florida Business Journal: NICB: Suspicious insurance claims up

“The number of suspicious insurance claims rose to 41,619 in the first half of the year, up from 36,743 in the prior-year period, according to a review of insurance claims referred to the National Insurance Crime Bureau.”

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[Post from Infoglide] Data Finds Data in Real-Time Entity Resolution

“Jeff Jonas of IBM recently quoted from a chapter called “Data Finds Data”  that he co-wrote for a book entitled Beautiful Data: The Stories Behind Elegant Data Solutions, and I was impressed by how well this passage describes the effective use of entity resolution software (e.g., IRE 2.2)…”

IT-Director.com: GRC is not enough

[Philip Howard]”If you think about these different forms of risk, they can mostly be managed within existing GRC frameworks: business risk, data and IT governance and compliance cover five of these seven types of risk. But they don’t cover fraud or cyber attacks or similar security issues.”

SunSentinel.com: Roofer ducked $400,000 in worker’s comp premiums

“Investigators with the state’s Division of Insurance Fraud said Robert McDonald, owner of Gulfstream Roofing Inc., funneled $3 million in payroll through several fake companies between 2002 and 2006, claiming the money was being paid to insured subcontractors instead of his own workers.”

BNET Healthcare: What Can US Learn From European Health IT Experience?

“The three countries also use universal patient identification numbers in health care. This is much easier to do in Europe than it is in the U.S., where the mistrust of government is so high that the issue of having a single patient identifier number is no longer even under discussion. There’s also the small matter of our low EHR adoption rate, which is less than 20 percent for physicians and lower for hospitals. By contrast, most physicians in the three European countries are using some kind of EHR.”

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By the Infoglide Team

Francine Hardaway’s Blog: Are There Economies of Scale in Medicine?

“The efficiencies come when a group of physicians are all responsible for a patient’s continuity of care, and when they share information such as that possible with electronic health records (EHRs).”

Insurance & Financial Advisor: Poizner, industry oppose California downgrading of insurance fraud felonies

“‘Reclassifying 73 crimes including ‘false insurance claims’ is a disservice to the consumers and businesses in the state of California,” the letter said. “In addition, taking the power out of the hands of the public prosecutor to charge someone with a felony crime will have a serious impact on public safety.’”

BAM INTEL: A Growing Trend - Fusion Centers Connect Private and Public Sector Thinking

“The private sector owns about 80% of all critical infrastructure, and a communication disconnect could result catastrophically in a disaster scenario.”

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Poor Humana Insurance Co. In their 4Q earning report from 2006, the company stated that “Medical membership grew 4.2 million in 2006 to 11.3 million.” Unfortunately, this year Humana broke the law by using unlicensed agents to sell Medicare Advantage and prescription drug plans to Oklahoma seniors and was fined a hefty $500,000:

“Humana spokesman Jeff Blunt said the 68 agents in question were licensed, but not in Oklahoma. ‘What happened here was a border issue,’ Blunt said. ‘Oklahoma residents living near the border traveled across state lines or called an agent in another state and enrolled in a plan through those agents.”’

Actually, this was a database issue. And fixing the problem would have been easy, not to mention affordable.

The names of the Oklahoman customers were in a company database. The addresses of these Oklahoma residents were also in a database. And the names and addresses of the out-of-state agents who sold the plans were in a database. So why oh why then weren’t these new plans automatically rejected? Why couldn’t the data from the all the various databases be accessed to provide actionable business intelligence?

You know the CFO of Humana is asking that question now.

If Humana had only had the ability to tap into the data they already had in house, they could have saved themselves from a half million dollar fine, not to mention the bad publicity.

This is what Jeff Jonas has called “enterprise amnesia,” which happens when “an organization misses the obvious (e.g., when other relevant information is trapped elsewhere in their organization) and then takes incorrect action.” The problem is that the individual nuggets of information are too often contained in disparate silos - with no effective way to provide a “big picture” view that can be acted upon.

If Humana had had an identity resolution solution in place, they could have sifted through all their information — across different databases, systems and geographies. Then as the new plans came in from the agents the identity resolution solution could have searched the employee/agent database to ensure that the agents was licensed within Oklahoma.

Simply put, an identity resolution solution solves the enterprise amnesia problem — and prevents big fines — by allowing an organization to manage the identities of its customers, vendors, and employees across the enterprise.

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