“A recent article written by IAIABC Executive Director Greg Krohm does a great job of analyzing the effects that the Patient Protect and Affordable Health Care Act of 2010 (aka Obamacare) and the American Recovery and Reinvestment Act of 2009 are expected to have on the cost and administration of workers’ compensation programs. The indirect impact of the budgetary pressure put on state government budgets by the new federal requirements is troubling…”
“Among the most immediate changes will be more rigorous screening procedures for applicants seeking Medicare’s approval to bill the program for services. The law grants the DHHS broad discretion to subject applicants to criminal background checks, fingerprinting, unannounced site visits, and database checks.”
“TSA collects as little personal information as possible to conduct effective watch list matching. Also, personal data is collected, used, distributed, stored, and disposed of in accordance with stringent guidelines and all applicable privacy laws and regulations.”
“Surprisingly, it’s employer fraud that is the major type of workers’ comp fraud. According to a recent study reported by the National Commission on State Workmen’s Compensation Laws, over 13% of employers studied were operating without legally required workers’ compensation insurance. In addition, others were found to be cheating the system by intentionally misclassifying or underreporting their payroll or by falsely representing employees as independent contractors.”
So bad is the state budget pressure that some state workers’ compensation agencies have had to freeze hiring and sharply limit training and travel. This clearly hurts the efficient administration of workers’ compensation laws.
The increased costs come in several forms, all driven by the need to comply with the new laws. One example is the move toward a universal Electronic Health Record that dictates a standard medical record format that any agency touching the healthcare system must support. Workers’ compensation agencies aren’t explicitly called out since “medical bill payers are not covered entities under HIPAA” yet “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.”
What is clear is that there will be a financial impact on state workers’ comp agencies, and no provision was made in the legislation to cover increased costs necessitate by the new rules. Despite the impending pressure on state agencies, they will be expected to continue efficiently administering the system in the face of budget and personnel cuts. Increasing efficiency by doing more with less will lead to an increased usage of advanced technology such as entity resolution.
“They were investigating allegations that Abdirahman’s visitor, local pharmacist Marcelleus J. Anunobi, had been soliciting people for similar information that the agents say he used to commit up to $2.5 million in Medicaid fraud. Abdirahman is one of several people subpoenaed this week to testify in the case of Anunobi, who since 2007 owned the now-closed Advanced Doctor’s Prescribed Pharmacy on Medical Drive.”
“What is watchlist matching? It’s when a passenger is prescreened using their name, date of birth and gender (that should match the information on their approved official government ID) against government watchlists for domestic and international flights. Actual names on the list are identified by the FBI’s Terrorist Screening Center as being people who may pose a known or suspected threat to aviation.”
“The NYSIF said it conducted 16,422 safety surveys and 2,228 safety training presentations for policyholders during the year. Its anti-fraud efforts saved an estimated $16.6 million and led to 154 arrests, 1,246 investigations and 584 cases referred for prosecution.”
“Notwithstanding the fact that IT seems to always have the latest, greatest thing on its mind, cloud computing has the entire IT industry excited, with companies such as IBM, Microsoft, Amazon, Google and others investing billions of dollars in this new form of computing. And in terms of IT users, Gartner recently named cloud computing as the second most important technology focus area for 2010.”
“This past year, CMS paid approximately $60 billion to criminals impersonating doctors and patients in order to file false claims. Medicare and Medicaid fraud not only affects those covered by the insurance plan, but every single taxpayer nationwide, regardless of party affiliation, Murphy said.”
“Investigators said the business is engaged in roofing and demolition work, but that the DiNapolis allegedly misrepresented themselves as cleanup contractors for debris at demolition sites of other contractors. They allegedly also falsely gave their business location as upstate Jefferson, NY, rather than Kings Park, which further resulted in paying a lower workers’ comp. premium.”
“The facility would also serve as a regional ‘fusion center‘ favored by the U.S. Department of Homeland Security, Gillison said, with at least one federal intelligence analyst to coordinate street-level intelligence nationally and among 11 counties in Pennsylvania, New Jersey, Delaware, and Maryland. It also would become headquarters for the Southeast Pennsylvania Regional Task Force, the five-county panel of emergency-response officials that coordinates antiterrorism and disaster efforts.”
“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. Such willingness to work around licensing regulations can also signal a cavalier attitude about providing workers’ compensation insurance to employees as required by law.”
“The IOC-2 is co-located at the Organized Crime Drug Enforcement Task Forcefusion center and the DEA’s Special Operations Division Command Center, which are both in northern Virginia. Partner agencies meet in a task force setting where they provide information and intelligence reports that might pertain to international organized crime. When Holder announced the center, he also emphasized the importance of continued cooperation with foreign law enforcement through existing police-to-police and mutual legal assistance mechanisms.”
“The state of Kansas has been conducting ’sting’ operations to prevent this kind of theft by lottery terminal clerks. Law enforcement agents fanned out across the state and presented ‘winning’ tickets at several retail lottery outlets. In five separate cases clerks told the agents the tickets were worthless and then tried to redeem the ‘winning’ lottery tickets. The undercover investigation led to charges of attempted theft and computer crime against five people across the state. Lottery officials across the country advise lottery players to check their own tickets.”
“Costa said that a more effective fight against the crime syndicates requires shifting ‘focus from disrupting the mafias to disrupting their markets’ through tighter measures to combat money laundering and corruption. He also suggested cracking down on the accomplices of crime ‘like the army of white-collar criminals — lawyers, accountants, realtors and bankers who cover up and launder their proceeds.’”
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. Such willingness to work around licensing regulations can also signal a cavalier attitude about providing workers’ compensation insurance to employees as required by law.
Many organizations face the challenge of identifying individuals or businesses that intend to deceive by altering their identity in some manner. Detecting employer fraud in workers’ comp is an example that has been highlighted in a journal article:
In order to avoid paying premiums, a company’s owners may illegally classify permanent employees as contractors. Alternately, they may operate for some time without paying their premiums, and then when the insurer is about to take action, they simply shut down the company on paper and reconstitute it under another name. Companies also use this “going out of business” ploy in cases where their experience (or modification) rating has gone up due to multiple injuries, thereby resulting in higher premiums. By reopening as another company, they can effectively reset their experience rating.
Entity analytics uses a combination of similarity searching and transitive matching to alert authorities about companies or contractors that advertise themselves as open for business and who are related to companies or contractors as known offenders. Enhancing existing systems in this way with entity resolution makes them even stronger.
“Crown prosecutors said they will likely be able to collect about $6.1-million, about $450,000 less than what Mr. Malik owes from the original winnings, including interest. That money will be returned to the Ontario Lottery and Gaming Corp., which paid the money to the real winners, plus interest, when it discovered Mr. Malik’s fraud.”
“ICE’s experience in trade-based money laundering investigations has shown that one of the most effective ways to identify instances and patterns of trade-based money laundering is through the exchange and subsequent analysis of trade data for anomalies that would only be apparent by examining both sides of a trade transaction.”
“McClain heads up Contractor Compliance for the agency and has just 27 inspectors to cover the state. The agency registers 55,000 contractors each year, so reigning in folks like Mulinski is a difficult task. ‘Finding them working on a job site is a real challenge,’ he said. Once we find them there, knowing that they are registered, who are employees and who are workers?’”
“Stories about financial services fraud are on the rise. Consider the recent article about an employee of a financial services company who had charges filed against him for conspiring to rig bids for investments in municipal bond projects…”
“According to court documents: Zaino engaged in a bid-rigging conspiracy from at least as early as October 2001 until March 2006. As a part of the bid-rigging conspiracy, Zaino, acting as a broker of investment agreements, and co-conspirator providers designated in advance which co-conspirator provider would be the winning bidder for certain investment agreements brokered by Zaino’s employer.”
“‘ASTA has and will continue to work closely with the TSA to notify members through member alerts and updates, of upcoming changes and deadlines that impact the travel agency community and the traveling public. We have, throughout the implementation period, met with TSA and provided updates and direction to our members regarding compliance,’ said ASTA President and Chair Chris Russo.”
“It’s been quite awhile since we’ve addressed the challenge of balancing security and privacy. As authors of the software used more times every day than all other identity resolution software combined (video: Who Is Infoglide Software?), we are extremely conscious of how critical it is to strike a balance every day that ensures the security and protects the privacy of U.S. citizens.”
“‘Wachovia Bank willfully failed to establish an anti-money laundering program,’ said U.S. Attorney Sloman. Without a program to detect money laundering, here’s what happened: From 2003 to 2008, $420 billion flowed through Wachovia Bank from Mexico – including all that drug money – with no effective oversight.”
“He also said that regional cooperation among agencies has improved greatly, particularly with the East Valley Gang and Information Fusion Center, where authorities sift through crime leads and data to battle crimes across city boundaries. The center allows Valley agencies to quickly share information on crimes and suspects.”
“The Department of Health and Human Services, under which Medicare and Medicaid operate, beefed up the Recovery Audit Contractor program. This program, begun in 2005, uses contracted “bounty hunters” to recover improper paid monies. They receive a percentage of recovered dollars as a bounty. Sophisticated computer programs used to identify patterns of errors as well as other high-tech methods should improve the amount recaptured.”
It’s been quite awhile since we’ve addressed the challenge of balancing security and privacy. As authors of the software used more times every day than all other identity resolution software combined (video: Who Is Infoglide Software?), we are extremely conscious of how critical it is to strike a balance every day that ensures the security and protects the privacy of U.S. citizens.
As fusion centers proliferate, the tension between those who protect us from physical harm and those who protect our right to privacy plays out in public meetings. In Austin, for example, every meeting about the new Austin Regional Intelligence Center is well attended by law enforcement agencies who are challenged daily to keep citizens safe and by groups like the ACLU who point out the dangers of invading the privacy of citizens that fusion centers are meant to protect.
Although fusion centers highlight the privacy/security clash in a public way, any use of powerful identity resolution technology to catch people with bad intent must be weighed against the rights to privacy and confidentiality that we all enjoy. In every instance that the technology is applied – detecting money laundering, solving lottery ticket theft, monitoring retail merchandise exchange, uncovering workers’ comp employer cheating, and other uses – care must be taken to apply it judiciously and only in ways needed to achieve narrow objectives while always protecting individual liberties.
I have always believed that the back and forth between all of the stakeholders is healthy for our society and I continue to believe that today. At Infoglide Software we are proud to be the “Gold Standard” for entity and identity resolution software and we are mindful of the balance that is required in the application of our technology.
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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