“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.”
“On November 1, the Secure Flight program achieved a key goal as described on the Transportation Security Administration (TSA) web site: Secure Flight, the Transportation Security Administration’s (TSA) behind-the-scenes watch list matching program, fulfills a key recommendation of the 9/11 Commission by assuming responsibility of watch list matching from individual airlines. By establishing a consistent watch list matching system, Secure Flight enhances aviation security and more effectively facilitates air travel for passengers.”
“With a simple text message system you can bring the power of a supercomputer to the cheapest and simplest mobile phones via cloud computing. For many important applications there is no need to place supercomputing power in the device itself. Simple cell phones can act as smart phones today, thanks to the cloud. That’s an amazing technological advance.”
“The hospital, according to Field, allegedly paid a doctor $12,000 a month in Medicare money to serve as a medical director and to get patients admitted into a nonexistent program for women with post-traumatic stress disorder. Field also alleged the hospital billed Medicare for services to psychiatric patients without the doctor certification statements required by the government. ‘In essence it appeared that what the hospital was doing was obtaining reimbursement from the federal government for medically unnecessary psychiatric services,’ Assistant U.S. Attorney Lisa Palombo said.”
“‘He has taken no responsibility for his conduct,” Kamiabipour said. ‘When he gets out, he’ll do it again.’ Petronella’s attorney, Tom Dunn, said the sentence was fair, though he would have liked to see his client get less time. Dunn also commended the judge for his “thoughtful and sound” decision on restitution. State officials and prosecutors say the couple operated a $38 million workers’ compensation insurance-fraud scheme.”
Secure Flight, the Transportation Security Administration’s (TSA) behind-the-scenes watch list matching program, fulfills a key recommendation of the 9/11 Commission by assuming responsibility of watch list matching from individual airlines. By establishing a consistent watch list matching system, Secure Flight enhances aviation security and more effectively facilitates air travel for passengers.
It’s an important achievement for the Secure Flight team. As part of that team, we are aware of how seriously all involved take their responsibility to keep people with ill intent off airplanes that fly into, out of, and over the United States.
With this latest announcement, the responsibility for comparing passenger manifests with the government’s lists of potential bad actors shifted from the individual airlines to TSA. During the past year, each airline transitioned to a process of requiring standard, minimal information (full name, date of birth, and gender) needed to ensure accuracy and minimize false positive identifications.
As a Secure Flight contractor since 2002, we have a sense of pride and ownership in reaching this milestone. As I noted in a post here 18 months ago, “given the critical nature of the program and with requirements for processing millions of transactions per day, Secure Flight is one of the most demanding and advanced applications of identity resolution and entity analytics technology to date. We feel privileged and grateful for the contributions we’ve had an opportunity to make to this important endeavor.”
“In addition to 12 years in state prison, Montes was ordered to pay more than $1.7 million in restitution with more than $286,000 ordered for FTB for failing to file and report almost $1.5 million in income relating to the insurance fraud during the years 2004, 2005 and 2006.”
“The DHS Office of Intelligence and Analysis, where I serve, takes information and intelligence from across DHS and the national Intelligence Community, processes and analyzes it, and then shares it with the fusion centers, often in joint products with the FBI. The fusion centers then disseminate it to the some 18,000 state, local, tribal, and territorial law enforcement organizations, and to thousands more first responders throughout the country.”
“We’re currently in the heat of the election season. No matter how impeccable the record of any candidate that the major parties put forward, minions of the opposing parties go to great lengths to uncover an embarrassing incident that can be exposed (or even an incident that can be twisted to appear embarrassing) in order to influence voters away from voting for that candidate. While the populace is reasonably good at figuring these tricks out, even more disturbing are the stories involving voter fraud.”
“Also, many data quality vendors specialize and provide depth of expertise in a focused part of the data quality market such as postal address verification (e.g., Experian QAS, Melissa DATA), matching or identity resolution [e.g., Infoglide Software, Netrics (acquired by TIBCO Software), and Pervasive Software], and data profiling (e.g., Ab Initio and Business Data Quality).”
“The R.I. State Fusion Center, a state police unit that tracks information on homeland security and crime, assisted in the investigation through the use of facial recognition software that determined that Medrano had been previously issued a Massachusetts identity document in his real name.”
“While TSA’s watch-list matching takes seconds and can be completed up until the time of departure, the agency cautions passengers that a boarding pass will not be issued until the airline submits complete passenger data to Secure Flight. The agency noted that, despite the crackdown, minor variations in the name on the boarding pass and ID, like middle initials, should not present problems at checkpoints.”
We’re currently in the heat of the election season. No matter how impeccable the record of any candidate that the major parties put forward, minions of the opposing parties go to great lengths to uncover an embarrassing incident that can be exposed (or even an incident that can be twisted to appear embarrassing) in order to influence voters away from voting for that candidate. While the populace is reasonably good at figuring these tricks out, even more disturbing are the stories involving voter fraud.
Take the case of absentee ballots being requested by someone other than the actual person. According to a recent news story, this has happened in multiple places across the country already this year, including the states of Pennsylvania, New York, Nevada, and Florida (surprise). A common theme is that votes are cast using absentee ballots in the names of people who later say they never requested the ballots and didn’t vote absentee.
Some fraudulent “voters” were found to have made up creative excuses about why they needed to vote absentee. In other cases, a person knocked on the door and convinced the person answering to sign a “petition” that later turned out to be an absentee ballot.
Given what Infoglide does, it’s easy to speculate how to solve these problems using identity resolution technology. Many data sources found in the surface web, dark web, and social media contain a wealth of information about every voter, so it shouldn’t be that hard to construct a solution. For example, imagine if when someone asked for an absentee ballot, their identifying information was entered and they were asked a random question about their background that another person would be unlikely to know?
While anything is possible with existing technology, the harder problem is getting the affected political parties to come to a consensus on a solution. Now that would be something to get behind!
“On the one hand, recognition of the power that entity resolution can bring to bear on challenging problems both in the commercial and public realms continues to increase. On the other hand, resistance to change and lack of budget seem to be inhibiting dramatic increases in productivity and effectiveness that could be gained by a more rapid uptake of this new technology.”
“Cloud computing, social computing, context-aware computing, and pattern-based strategy are the four big trends that will alter IT in the next few years, according to Peter Sondergaard, SVP of Research for Gartner… Each of these trends is disruptive, he said, but the combination is an ‘unimaginable force’ that will transform not just IT, but business and government.”
“The TSA estimates that only about 1 percent of travelers won’t make it through security because of a discrepancy, Kimball says. Although it’s unlikely you won’t be able to fly because of a mishap, you still might be delayed if your ID and ticket don’t match up. That hold-up will likely be less than five or 10 minutes while screeners verify your ID and boarding pass, Orbitz’s Tornatore estimates.”
By Mike Betron, Infoglide Software Director of Marketing
On the one hand, recognition of the power that entity resolution can bring to bear on challenging problems both in the commercial and public realms continues to increase. On the other hand, resistance to change and lack of budget seem to be inhibiting dramatic increases in productivity and effectiveness that could be gained by a more rapid uptake of this new technology.
A few days after the 2009 Christmas Bomber incident, President Barack Obama made this statement:
“The bottom line is this: The U.S. government had sufficient information to have uncovered this plot and potentially disrupt the Christmas Day attack. But our intelligence community failed to connect those dots, which would have placed the suspect on the ‘no fly’ list. In other words, this was not a failure to collect intelligence; it was a failure to integrate and understand the intelligence that we already had. The information was there.”
Being able to connect the dots by using readily available data is every bit as challenging for private companies. Many commercial organizations (e.g., insurance companies, banks), similarly have all the right data available to them to solve problems related to identity.
While some people are skeptical that we’re making enough progress in developing and using advanced analytics, we’re certain that the remaining issues are solvable using available entity resolution technology in conjunction with readily available data. It’s more a matter of will and resources than lack of capability that’s holding us back.
“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 $163 million, the largest fraud by one criminal enterprise in the program’s history, U.S. authorities said Wednesday. Federal prosecutors in New York and elsewhere charged 73 people.’”
“After the Sept. 11, 2001, terrorist attacks, the U.S. government encouraged and funded a proliferation of domestic counterterrorism centers, commonly referred to as state and local homeland security fusion centers. Although 72 centers now exist, only 28 have privacy and civil liberties plans approved by the Homeland Security Department, National Journal has learned.”
“Worldwide Cloud Computing market is continuing to grow at a rapid rate and it is expected to cross US$ 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.”
“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.”
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. Most of the defendants were captured during raids Wednesday morning in New York City and Los Angeles, but there also were arrests in New Mexico, Georgia and Ohio.
The latest installment in this ongoing saga includes billing for unnecessary and never performed procedures, stolen identities, and phony clinics:
The defendants in the New York case also had stolen the identities of doctors and set up 118 phantom clinics in 25 states, authorities said. The names were used to submit fake bills for care that was never given, they said.
How can those responsible for payments not detect phony clinics? Many sources of public and private information are available to validate their existence, yet apparently systems to perform this function are not in place 45 years after Medicare was created. As Mike Shultz said here in a June post:
Honest suppliers stand by helplessly as competitors cash in on the bonanza. One such supplier wrote in a guest post about how current detection methods are inadequate and how the problem can be attacked with the right technology.
Several months ago I asked the question, that if “every day, identity resolution software screens every airline passenger on every U.S. domestic flight to prevent known criminals and terrorists from boarding airplanes without being detected,” then “could the same technology be used to make the whole Medicare and Medicaid infrastructure more proactive in preventing fraud?” The answer is still “yes.”
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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