Identity Resolution Daily

By the Infoglide Team

BND.com: Insurance fraud investigators begin probe into workers’ comp claims at Menard

“A total of 389 guards and other workers have filed more than 500 claims, including about 290 still pending. About 230 of these claimed injury for the underlying cause of ‘repetitive trauma,’ including carpal tunnel syndrome, an injury of the wrist. The prison employs about 760 workers, of which 567 are guards. ‘The Department of Insurance is investigating recent questions raised in connection with workers’ compensation claims filed against the state of Illinois at the Menard Correctional Center,’ department spokesman Louis Pukelis said Tuesday in a written statement.”

HSToday: Fusion Centers: Tough Tightrope 

“As states and localities have put up fusion centers designed precisely to overcome this, however, they’ve had to face a different challenge: ensuring not only the quantity but the quality of information they collect and report. In candid conversations with Homeland Security Today, leading privacy advocates, scholars and state law enforcement and federal officials addressed some of the key facets of this challenge, as well as steps that can be taken to ensure that fusion centers live up to their full potential as a counterterrorism tool.”

StarNewsOnline: North Carolina collects big from Medicaid fraudsters

“North Carolina’s Medicaid fraud investigators pulled in millions last year through dozens of cases of fraud and patient abuse, the state’s attorney general’s office reported Monday. The office’s Medicaid Investigations Unit prosecuted 22 criminal convictions and 18 civil settlements, recovering $53.5 million, during the federal fiscal year that ended Sept. 30, according to a press release from N.C. Attorney General Roy Cooper.”

ReadWriteWeb: What Cloud Computing Means For Small Businesses

“Needless to say, it’s a huge deal. Gartner recently put cloud computing at the top of its list of top strategic technologies for 2011 and it’s far from the only expert extolling the glory of the Web-hosted software and infrastructure. For small businesses, the significance of this primarily comes down to cost. In many cases, using cloud-based infrastructure is cheaper than running and maintaining one’s own physical servers.”

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By the Infoglide Software Team

Cliffview Pilot: Fighting crime with modern tools amid budget cuts

“Professional analysts and law enforcement officers from more than 15 different agencies including the FBI, ATF, DEA, US Marshall’s, Homeland Security, and state and county partners work from one large room to put out intelligence products in a truly collaborative environment that defines New Jersey’s fusion center. Products include crime mapping with predictive analysis to help local departments know when and where crimes are likely to occur in the future.”

Thomasville Times-Enterprise: Pharmacist fraud

“Morgan’s prison sentence will be followed by three years of supervised release. Morgan was ordered to pay restitution of $2,804,462. Morgan, 64, was convicted in October 2008, of 69 counts of health care fraud, following a two-week jury trial in Albany. Michael J. Moore, U.S. attorney for the Middle District of Georgia, said the indictment charged that for a period of several years ending in August 2007, Morgan, a registered pharmacist and the owner of Thrift Center Pharmacy in Camilla, executed a scheme to defraud the Georgia Medicaid program, which is jointly funded with state and federal funds.

FATF: Money Laundering Using Trusts and Company Service Providers [PDF]

“TCSPs are often involved in some way in the establishment and administration of most legal persons and arrangements; and accordingly in many jurisdictions they play a key role as the gatekeepers for the financial sector. This report provides a number of case studies which demonstrate that TCSPs have often been used, wittingly or unwittingly, in the conduct of money laundering activities.”

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By Mike Betron, Infoglide Software Director of Marketing

Immediately after the Christmas bomber incident in 2009, we highlighted the positive role that broader deployment of (id)entity resolution software could play in preventing terrorist actions. That thought was seconded this week in a piece published by the Canadian Broadcasting Company (CBC) entitled “Better data analysis for a safer world”:

The technology to connect the dots from disparate data sources already exists, and has done for quite some time. It’s called “entity resolution,” and corporations have been using it for years to compile and ensure accuracy in consumer data. Entity resolution can help avoid many of the mistakes that led to the attempted Christmas bombing: it can overcome spelling errors in databases, alert the right people to a threat in real time, and correlate literally billions of records on an ongoing basis.

As we pointed out 11 months ago, not all identity resolution software has the same capabilities:

… some technologies rely on strategies that actually destroy the forensic integrity of the data. Not all identity resolution technologies are the same. Ours can be configured using a number of strategies to fit particular customer performance requirements, sensitivity to false positives or false negatives, and Similarity Search behaviors, including specialized name algorithms that catch misspellings, nicknames, and ordering variations.

The CBC article suggests how expanding the current uses of entity resolution software could bring added benefits:

If the agencies that held these disparate pieces of information were connected and running entity resolution software, red flags would be raised automatically, and those warnings quickly transmitted to the people who make decisions. The same level of intelligent technology and data analysis is important in business, where entity resolution originated.

That last statement supports our January post where we mentioned other uses for the technology:

Although the consequences are grimmer in homeland security situations, the challenges are the same for financial, healthcare, gaming, state and local government, and marketing applications.

The CBC article delineates how businesses benefit from entity resolution:

Knowing who your customers are, where they live, and what they are interested in gives your business a serious advantage - but for large organizations, that requires processing massive amounts of information. The potential for inaccuracies, duplication, and mistaken identity means that companies may be led into poor decisions by misrepresentative data. Entity resolution software was developed to mitigate these risks, and automatically format and clean up the available information.

CEO Mike Shultz has pointed out that our specific technology is “used more times every day for terrorist matching” than any other entity resolution software. Thankfully, the worlds of both business and government seem to be getting the message about the critical importance of this technology.

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By the Infoglide Team

Main Justice:Eric Holder’s Prepared Remarks at Health Care Fraud Prevention Summit

“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.”

SearchDataManagement.com: Gartner Magic Quadrant ranks MDM software vendors

“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.”

The Crime Report: Fusion Centers Could Face Budget Issues As States Cut Back

“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.”

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By the Infoglide Team

NY Post: Deli clerk tried to scam Lotto winner out of $14M

“McCassell gave the ticket to a clerk — but when the clerk scanned it, he ‘told him that it wasn’t a big winner,’ New York Lottery Director Gordon Medenica said. When McCassell asked for the ticket back, the clerk told him ‘he had lost the ticket,’ Medenica said. ‘The clerk said, ‘I already threw it away.””

CivSource: New report urges state and local governments to be strategic about analytics tools

“‘State government cannot afford redundant and disconnected investment — even in the best of times. And right now, we’re in the worst of times,’ he said in a statement. According to the INPUT report, released earlier this year, the market for state and local BI / audit and recovery (A&R) technologies will increase at an annual growth rate of 7.6 percent, topping out at over a billion dollars in 2014. Cumulatively, INPUT believes states will invest $600 million in A&R solutions, and $225 million in BI and prevention solutions in 2010 for the five biggest federal benefits programs.”

MassDevice: Clinical Science coughs up $525,000 to settle Medicaid fraud allegations

“‘We will continue to work with our state and federal partners to police abuse of the program that so many people depend on,’ Coakley said in prepared remarks. Over the last three years, Coakley’s Medicaid fraud division has recovered approximately $125 million for the state Medicaid program, according to the AG’s office.”

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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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[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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By the Infoglide Team

All247News.com: Medicare Fraud: Updates on Government’s Efforts to Recover Money Lost to Scam Artists

“Medicare fraud and billing errors costs the government more than $36 billion last year, the Economist noted. The modus operandi involves a “care-provider” billing Medicare for non-existent or unnecessary services. These services and items include: HIV/AIDS medicines and therapy; medical equipment such as wheelchairs to neck and knee braces, as well as home health care, physical and occupational therapy and mental-health services.”

CBCnews: Crime proceeds crackdown looms

“Another method used by organized crime is to pay a 10 per cent premium for winning lottery tickets or to buy jewelry in Canada worth tens of thousands of dollars and sell it in the U.S., achieving money laundering and foreign exchange conversion at the same time.”

San Antonio Express-News: Police ‘fusion center’ on the way for S.A.

“Each center can have an individual purpose, McManus said. The South Texas center will have two branches: one working on homeland security, bolstered by a new San Antonio Police Department Terrorism Criminal Intelligence Division, the other a 24-hour tactical operations center for ‘all crimes and all hazards as they occur in San Antonio and the region.’”

Washington State Wire: Will a ‘September Surprise’ Derail Workers’ Comp Initiative?

“Schurke said a fraud-prevention effort launched in 2005 has increased collections dramatically. Collections due to L&I investigations have increased 40 percent, to $770 million. The department has invested in advanced computer technology that should make it easier to track down employers who are not reporting fully. The systems will make it possible to compare 20 state and federal databases, including the IRS.”

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By the Infoglide Team

The Post and Courier: Fighting fraud: Link between bogus insurance claims, recession is murky

“At the national level, the number of potential fraud cases continued to rise throughout the first half of the year. Figures released last week by the Illinois-based National Insurance Crime Bureau show a 14 percent increase in questionable claims of the year in four of the six categories the agency tracks… Nationally, reported incidences of suspected organized insurance fraud cases grew 65 percent to 1,837 cases during the first six months of 2010 compared to the same period in 2008, according to the National Insurance Crime Bureau.”

Center for Investigative Reporting: Maryland to store license-plate scanner data at intel fusion center

“The initiative makes Maryland among the first nationally to establish a statewide network for data generated from license-plate readers. While the devices have not endured regular scrutiny and occasional opposition the way public surveillance cameras have historically, the technology in many respects is more powerful. Privacy advocates warn that plate recognition enables police to document where drivers go – both guilty car thieves and innocent citizens alike – by registering their GPS locations when each license plate is scanned. Police need reasonable suspicion that a crime has been or will be committed for much of the contact officers have with the public, at least in theory. But laws that restrict data gathering by law enforcement don’t always keep up with the 21st century.”

Fidelity.com: HSBC says subject of U.S. money laundering probe

“American authorities are investigating the U.S. division of global banking group HSBC over its compliance with anti-money laundering procedures, according to a regulatory filing… ‘These examinations and inquiries pertain to, among other matters, our global banknotes business and our foreign correspondent banking business, and our compliance with the Bank Secrecy Act, Anti-Money Laundering and Office of Foreign Assets Control requirements,’ the filing said.”

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[Post from Infoglide] 21st Annual ACFE Fraud Conference & Exhibition

“If you’re involved in fraud detection, then you’re probably aware of ACFE, the Association of Certified Fraud Examiners. With over 50,000 members, it’s the largest single fraud anti-fraud organization in the world. ACFE is also the publisher of FRAUD magazine. Starting Sunday, July 25 and continuing through Wednesday, July 28, the 21st Annual ACFE Fraud Conference & Exhibition will be held at the Gaylord National Resort and Convention Center in National Harbor, Maryland. If you’re attending, please come by and meet us at Infoglide Software Booth 329…”

Washington Examiner: Maryland recovers nearly $26.5 million in Medicaid fraud

“Brown said the False Health Claims Act, which goes into effect Oct. 1, will allow the state to recover even more dollars. Since 2006, the Department of Health and Mental Hygiene has identified or recovered more than $100 million in Medicaid fraud and waste, according to DHMH Inspector General Thomas V. Russell.”

Jeff Jonas: Hell with Rules

“Data triage systems, especially those that must detect ever-changing crafty adversaries, should be principle-based where possible; otherwise, you won’t be one step behind.  You will be at two or more steps behind… The notion that “principles outperform rules” probably applies to most, if not all, of the decisioning processes.”

Orange County Register: O.C. man fights state’s ‘fraud epidemic’

“Smith insists, ‘For every dollar they spend, they’d get $100 in income and sales tax revenue. The government doesn’t know how to find the companies that cheat ’so they just come hassle guys who comply with the law,’ Smith says. ‘They spend a lot of man hours and find little.’”

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