Identity Resolution Daily

By Douglas Wood, Infoglide Senior VP

The Association of Certified Fraud Examiners (ACFE) held its annual conference and exhibition in Washington, DC this week.  Through the keynote address and the plethora of wonderful speakers, one message became loud and clear - fraudsters are becoming more and more creative in finding ways to circumvent your policies.

We heard stories of insider trading, bust-out fraud, mortgage fraud, insurance claims fraud and organized retail crime.  Despite the diligence and hard work by the certified fraud examiners, too many of these stories ended up with a common theme - the crooks got away with an awful lot of booty before getting caught.

Predictive analytics and behavioral analytics have provided organizations with a great weapon in combating fraud.  Establishing norms and ranking activities against those norms can have a dramatic effect on reducing losses to fraud and crime.  What has been missing, however, is the wide-scale adoption of a tool that allows fraud examiners to “automatically connect the dots” between the bits and pieces of forensic information they have.  Identity Resolution is that tool… and it has been the talk of the conference here.

The powerful federated similarity search capabilities of identity resolution help investigators understand the hidden relationships between individuals across enterprise data (Applicants, SARs, Incidents, Employees, Claimants, Witnesses, etc).  Let’s face it, the fraudsters are typically not stupid.  They know how to get around the systems by engaging their family and friends to form a profitable fraud ring.  Identity Resolution gives companies the power to search into ALL their data with  a view to understanding “who’s who” and “who’s working with whom” - despite deliberate attempts to deceive.

We believe this technology is becoming absolutely critical for corporations to predict and examine fraudulent activity, and that mainstream adoption is happening right now.

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By the Infoglide Team

Bloomberg: Banks Financing Mexico Gangs Admitted in Wells Fargo Deal

“Wachovia admitted it didn’t do enough to spot illicit funds in handling $378.4 billion for Mexican-currency-exchange houses from 2004 to 2007. That’s the largest violation of the Bank Secrecy Act, an anti-money-laundering law, in U.S. history — a sum equal to one-third of Mexico’s current gross domestic product.”

HIMSS: Informed Patient Identity Solution

“The identification of the patient is not always accurate in healthcare. Information for one individual may exist in one or multiple databases where it resides as ‘duplicate,’ inaccessible or unknown to those needing to see the complete or most current picture. Due to administrative errors, information on two different individuals can be ‘overlaid’ and presented as one person’s record. Linking the wrong clinical information to a person not only can cause great personal harm to the patient, but also can incur huge costs to the healthcare provider in correcting and mitigating the error.”

ExecutiveGov: Napolitano Announces Progress in 9/11 Commission Security Recommendations

“‘By working with our partners across the globe, we have achieved historic advances in international aviation security – including bolstering explosives detection, strengthening the vetting of passengers against terrorist watchlists, refining passenger screening techniques and deploying tens of thousands of trained aviation security personnel—that make air travel safer for everyone.’ Among other things, the report showed that aviation security received a large boost with the implementation of Secure Flight for 100 percent of passengers flying domestically and internationally on U.S. airlines.”

ERIQ: 15th Annual ICIQ Conference in Little Rock, AR, November 12-14, 2010

“The Donaghey College of Engineering and Information Technology at the University of Arkansas at Little Rock (UALR) will host the 15th International Conference on Information Quality  (ICIQ) on November 12-14, 2010.  The  ICIQ attracts researchers and practitioners in the academic, public and private sectors from across the globe.”

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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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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!

The conference is geared to address the challenges faced by anti-fraud professionals, featuring top-level educational sessions and providing a great forum for participants to network with colleagues. Join us in Washington, D.C. and experience for yourself why this is the most important event for anti-fraud professionals.

If you would like to schedule some time to meet with Infoglide representatives, please contact us at sales@infoglide.com.

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By the Infoglide Team

CNSNews.com: New Regulations Outline Content, Transmission Standards for Every Americans’ Electronic Health Records

“The EHRs are designed to be digital replications of the hard-copy, paper health records commonly in use today. They are also engineered to be easily transferable among different doctors and hospitals so as to eliminate the creation of duplicate or disparate records among different health care providers, thus allowing any health care office to access a patient’s complete medical record at each visit.”

Washington Post: Firms slow to embrace cloud computing

“‘There’s an awful lot of talk about it and there is consumption of cloud,’ said Al Gillen, an analyst at IDC. But ‘organizations don’t simply make change because they can. There has to be good justification.’ Harry Weller, a general partner at New Enterprise Associates, said start-ups and new businesses will likely be among the first to move to the cloud. A need to hold down costs is often an overriding factor in their decision, he said.”

Detroit Free Press: Arrests made for Medicare fraud

“Many of the charges involved home health care companies that billed Medicare for equipment or treatment that many patients didn’t need or never received. In several cases, people who worked for the companies were paid to recruit patients to participate in the scheme. Some persuaded elderly people to sell their Medicare identification numbers, which were used to rip off the system.”

Liliendahl on Data Quality: Data Quality is an Ingredient, not an Entrée

“Fortunately it is more and more recognized that you don’t get success with Business Intelligence, Customer Relationship Management, Master Data Management, Service Oriented Architecture and many more disciplines without starting with improving your data quality. But it will be a big mistake to see Data Quality improvement as an entrée before the main course being BI, CRM, MDM, SOA or whatever is on the menu.”

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[Post from Infoglide] Exposing Fraudulent Networks in Healthcare

“More than half of the $98 million in ‘improper payments’ by the federal government in 2009 were made through Medicare and Medicaid. A recent article in the New England Journal of Medicine points out that ’since 1990, the Government Accountability Office (GAO) has designated Medicare as a high-risk federal program because its vast size and complexity make it vulnerable to fraud, waste, and abuse.’”

CapitalSoup.com: CFO Alex Sink Announces Joint Investigation Arrests In Mortgage Fraud Crackdown

“Investigators discovered that Alan Weitz, vice president of Bal Bay Properties, and his son Brandon Weitz, working for the same company, recruited ’straw buyers’ who were offered $3,000 each to allow their names to be used on mortgage loan applications to purchase homes with the understanding that the properties would be quit-claimed over to an actual buyer.”

KXAN.com: Homeland Security praises new fusion center

“The Fusion Center, seeded with Homeland Security money, collaborates the effort and information of local, state and federal authorities. Austin’s Fusion Center is yet to be fully operational, but last February it played a critical role in the rescues at the Echelon Building.”

News 6: 94 individuals charged in the largest Medicare fraud case in history

“The defendants participated in schemes to submit claims to Medicare for treatments that were unnecessary and in many times never provided. The defendants include doctors, health care company owners, executives and others, which collectively defrauded Medicare for approximately $251 million.”

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By Mike Betron, Infoglide Software Director of Marketing

More than half of the $98 million in “improper payments” by the federal government in 2009 were made through Medicare and Medicaid. A recent article in the New England Journal of Medicine points out that “since 1990, the Government Accountability Office (GAO) has designated Medicare as a high-risk federal program because its vast size and complexity make it vulnerable to fraud, waste, and abuse.” The article goes on to discuss how to combat the fraud through better screening.

“Increasingly, federal investigators have found that the Medicare system is being infiltrated by criminals and organized criminal networks.” One solution suggested is “imposition of more stringent entry requirements on the 18,000 applicants who, in an average month, seek Medicare’s approval to bill the program for service.” Every day, identity resolution software screens every airline passenger on every U.S. domestic flight to detect known criminals and terrorists. Could the same technology screen 18,000 new healthcare program applicants every month?

The article suggests that the Department of Health and Human Services (DHHS) be empowered “to determine which Medicare providers should create internal compliance programs designed to make them more vigilant against fraud.” Today, banks and insurance companies are using identity resolution software to detect the social networks of fraud rings. Could the same technology with its similarity searching and hidden identity detection form the core of a new system that screens internal activity to monitor compliance?

“Kimberly Brandt, director of the CMS’s program-integrity group, emphasized that the newly granted authority would enable the agency to move away from its historical ‘pay and chase’ mode to focus greater resources on fraud prevention.” 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. Could the same technology be used to make the whole Medicare and Medicaid infrastructure more proactive in preventing fraud?

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By the Infoglide Team

wkyc.com: Ravenna: Police arrest store owner in Ohio Lottery claim investigation

“Lottery officials say the Lottery’s Office of Security is a statewide program developed by the Lottery and executed in cooperation with local law enforcement authorities. It is designed to protect Lottery customers by ensuring that winning tickets are not wrongfully claimed by retailers or their employees without payment to the customers. The program, a sting operation in which Lottery investigators posing as customers present tickets to be checked, is ongoing and is expected to yield additional arrests.”

insurancenewsnet.com: California Announces $29.8 Million in Fraud-Fighting Grants

“U.S. property/casualty insurer financial impairments have more than tripled since 2007, the last full year before the current recession, rising to 18 in 2009, up from 16 in 2008 and from five in 2007, according to a recent A.M. Best special report (BestWire, June 22, 2010). A.M. Best has found over the past 41 years of this study that the financial impairment frequency typically rises during and shortly after periods of economic and financial market stress.”

InvestmentNews: Who’s supposed to watch what?

“Updated anti-money-laundering regulations, pending trade-reporting rules and new custody rules for advisers are some of the initiatives that are raising questions about the division of compliance responsibilities. ‘Some of those lines [of responsibility have] blurred as regulators focus on anti-money-laundering,’ said Jeff Horowitz, director of compliance at Pershing. ‘Anti-money-laundering has morphed into anything to do with fraud, manipulation or low-priced securities.’”

iContactCommunity: Workers Compensation Budget Impact

“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.”

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[Post from Infoglide] Workers Compensation Budget Impact

“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…”

The New England Journal of Medicine: The ACA’s New Weapons against Health Care Fraud

“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.”

The TSA Blog: Secure Flight Q&A

“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.”

Ezine Articles: Tutorial on Workers’ Compensation

“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.”

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By Mike Betron, Infoglide Software Director of Marketing

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:

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.

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