Archive for the ‘Insurance Fraud’ Category

Identity Resolution Daily Links 2009-07-31

Friday, July 31st, 2009

[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.”

Identity Resolution Daily Links 2009-07-13

Monday, July 13th, 2009

By the Infoglide Team

CiOZone: Ask the CIO: What’s your data management strategy?

“Undoubtedly, the recession has interrupted—or scaled back—some MDM-related work. But as Aaron Zornes said during an interview just before the July 4th holiday, ‘It’s not as if projects like risk management or Anti-Money Laundering, or Know Your Customer can wait until the economy improves.’ Some work just has to go forward—rain, shine, or economic downturn.”

Insurance Journal: California Efforts To Reduce Prison Budget Would Hurt Fraud Fighting

“‘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. Insurance fraud is a serious crime that demands serious consequences,’ the Coalition Against Insurance Fraud, National Insurance Crime Bureau, National Health Care Anti-Fraud Association and the International Association of Special Investigation Units said in a joint letter to Schwarzenegger.”

mydesert.com: 6 accused of trying to steal winning lottery tickets in Coachella Valley

“Undercover investigators posing as customers handed clerks decoy winning tickets and asked if they had won, Jeandron said. Some of the clerks told the investigators that their ticket was not a winner, but then went on to file a claim with the Lottery to collect the winnings.”

HISTALK: Monday Morning Update 7/13/09

“I don’t have access to the full text of the article, but I truly believe that once the pain of getting EMRs running as data collection appliances is over (meaning we’ve got data collection clerks known as doctors and nurses in place, which is the ‘pain’ part), the benefit will be incredible.”

Identity Resolution Daily Links 2009-06-30

Tuesday, June 30th, 2009

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.”

Identity Resolution Daily Links 2009-06-27

Saturday, June 27th, 2009

[Post from Infoglide] The Real Test of Identity Resolution

“So the title ‘Catching Terrorists and Making the World a Safer Place’ certainly caught my eye! And the content of the post did not disappoint, as the author Chris Boorman of Informatica did a great job of crystallizing the issue that drove the creation of this blog over two years ago: ‘So how do we balance the freedom of movement we have come to expect as hard-working citizens with the need to spot terrorists?’”

[Post from Infoglide] Identity Resolution Daily on Twitter

“At Identity Resolution Daily, we often come across interesting tidbits about entity resolution, and now we can share them in real time. Just add our ID - @IDResolution - to your twitter sources. Happy tweeting!”

GreenvilleOnline.com: Consumers may see insurance rates rise

“According to Love, the average family spends about $1,000 more per year as a result of insurance fraud. That’s felt in higher insurance premiums, taxes, and the cost of goods and services, she said.”

Ezine: Fraud Alert - Lottery Retailers Win More Than Their Customers Do

California Lottery did an undercover sting where they brought, what they knew to be, a winning lottery ticket to a retailer to have it verified. They caught many retailers on hidden camera telling them that the winning ticket was a loser and, subsequently, went on to claim the money themselves. On top of that, a statistician studied big wins of lottery retailers in Ontario, Canada and found that retailers won big jackpots a lot more than you would statistically expect them too.”

data quality pro: Rethinking Data Quality: The Need for a Data Quality Profession

“Processes, projects, products – each of these contributes to the efforts to improve data quality. But they haven’t solved the problems individually or collectively. To really make substantial and sustainable differences in the quality of data we need to take a different approach. We need to think of data quality as a profession.”

Identity Resolution Daily Links 2009-06-08

Monday, June 8th, 2009

By the Infoglide Team

Biz-Tech:Insurance fraud claims on the rise

“‘When someone commits insurance fraud they’re not just stealing from insurance companies,’ said Sanger. ‘They’re stealing from fellow customers.’ A recent study from the N.I.C.B. shows property/casualty insurance fraud costs Americans nearly $30 billion each year.”

PCWorld: Push For Electronic Medical Records Must Slow Down, For Security’s Sake

“‘I look forward to medical records going electronic,’ said Howard Schmidt, the former White House cybersecurity czar, ‘but I have a tremendous amount of concern about building a really, really good healthcare infrastructure… and then securing it later.’ Schmidt spoke with PCWorld at RSA 2009.”

IT-Director.com: A Bulldog Puppy Emerges

“Microsoft has moved further in its plans to introduce a master data management (MDM) capability into its product line. Microsoft had previously purchased Stratature, an MDM vendor known for its dimension management, and has used this as the basis for its MDM offering, previously known as Project Bulldog.”

Tampa Bay Online: TSA wants better picture of travelers

“With gender and birth information, the system, known as Secure Flight, will be better able to prevent misidentification of passengers who have names similar to individuals on the watch lists and better identify those who appear to pose a threat, the TSA said.”

Identity Resolution Daily Links 2009-05-14

Thursday, May 14th, 2009

[Post from Infoglide] Let’s Be Reasonable

“A recent post, ‘Terrorist Watchlist, Troubling Flaws Revealed’, starts out by making a valid point. If the terrorist watchlist is flawed, then the name matching results against such a list will be flawed. The author then goes on to reach related conclusions through rationalization rather than reasoning.”

Acxiom: Prognostications for the New Year 

Identity resolution will get its due. Sure, you can call it infrastructure. Processing and rules intensive, customer identity resolution has been relegated to the underlying algorithms of third-party data providers, MDM, and data quality vendors. However, companies are recognizing that they may have unique customer data-matching needs-a bank we work with has more than 50 definitions of a household-and they’ll be looking at smarter, more specialized ways to automate them.”

Dallas Morning News: Dallas Police Department’s Fusion Center outsmarts criminals

“Chief David Kunkle, who championed the unit’s formation in January 2007, refers to it as the “brains” of a department that reported a 10 percent drop in crime last year and a nearly 19 percent decline in the first quarter of this year.”

datanomic: Fractured approaches to Sanctions Screening put UK Companies at risk, says new FSA report

“‘The use of multiple identities is common in the criminal world and Al-Qaeda’s own training manual requires its operatives to use false identities to hide their terrorist activities. Exploiting variations of a criminal’s real name is, perhaps, the simplest way of acquiring a new identity. Typical approaches are to use name variations or switching the order of names,’ added Pearson. ‘Other data, such as dates of birth are often manipulated simply by transposing digits.’”

Cloud Computing Journal: Experian QAS Launches QAS Pro On Demand

“‘By offering address verification in a SaaS model, we are enabling organizations of all sizes to maintain accurate contact data in a cost-effective platform,’ said Joel Curry, chief operating officer, Experian QAS. ‘As businesses change over time, our new infrastructure is able to adapt to shifting demands.’

Identity Resolution Daily Links 2009-05-08

Friday, May 8th, 2009

[Post from Infoglide] Lottery Fraud by Retailers Is an Identity Resolution Problem

“Lottery Post ran a piece last week on suspicious winnings in the North Carolina Lottery. It seems a regular lottery player contacted NBC affiliate WCNC in Charlotte about a pattern of winnings that seemed unlikely. The station’s investigators used the Open Records Act to obtain information from the lottery and subsequently uncovered that ‘of the lottery retailers winning prizes, some are amassing significant jackpots repeatedly — $100,000, $300,000, and $500,000 prizes — dozens of times a year.’”

Orange County Register: How did $38 million scheme work?

“Just as auto insurance rises for drivers with poor records, individual companies reporting high injury rates can see their premiums soar. When workers’ comp rates peaked earlier this decade, premiums in the construction industry were sometimes double or triple the payroll. A key factor behind the high rates was fraud: Employers under-reported the number of insured workers to reduce their payments, thereby driving up premiums for the industry which looked like it had a high accident rate for a small pool of workers.”

Travel Management: Industry Prepares For Secure Flight Implementation

“‘Meanwhile, many corporate travel agencies–from the largest mega travel management companies to smaller entities–have been working to adapt their agent scripts and booking tools to include required Secure Flight data collection, and their profile systems to help reconcile name discrepancies. We have undertaken a large update and enhancement of our internal profile systems to accommodate the storage of this very valuable and confidential information,’ according to Robert Polk, CEO of Polk Majestic Travel Group in Denver.”

Greensboro News & Record: Editorial: Luck has its limits

“It’s happened in other states. In March, Minnesota lottery investigators charged five retailers and three accomplices with fraud after an undercover sting operation found them allegedly trying to cash customers’ winning tickets for themselves. California launched a series of sting operations last year, which resulted in charges against retailers in several cities. In Iowa last month, the state ombudsman reported that lottery officials don’t adequately protect customers from fraud and theft by retailers.”

Identity Resolution Daily Links 2009-05-04

Monday, May 4th, 2009

By the Infoglide Team

NBC Dateline Video: Investigation into lottery fraud by retailers

“So how common are discounting and theft in other state lotteries? There’s no way to know because few states have investigative arms like the one we saw in California.”

ClaimsJournal.com: Father, Daughter Arrested for Workers’ Comp Insurance Premium Fraud

“The Haases allegedly underreported their companies’ payrolls from October 1, 2003, through February 11, 2008, to avoid paying $1,028,640 in premiums to State Compensation Insurance Fund (SCIF), Virginia Surety Co., and Reinsurance Corporation of America, the California Department of Insurance reported.”

Lottery Post: N.C. lottery store owners, employees winning big and often

“Buried in thousands of records of winners are other retailers — store owners winning $100,000 $300,000 and almost $500,000. And the reports show multiple winners. One employee of a store selling tickets in eastern North Carolina won 10 times in a little over a year — including a $100,000 jackpot.”

Identity Resolution Daily Links 2009-05-01

Friday, May 1st, 2009

[Post from Infoglide] Stuck in the Middle

“‘Clowns to the left of me, Jokers to the right, Here I am, stuck in the middle with you.’ One reason Identity Resolution Daily began two years ago was to create a venue to address privacy/security controversies.”

Business Week: California couple charged with big insurance fraud

“Prosecutors said the pair defrauded the State Compensation Insurance Fund, California’s biggest workers’ compensation insurer, of $38 million between 2000 and 2008 — the largest in state history.”

OCDQ Blog: El Festival Del IDQ Bloggers

“Welcome to the April 2009 issue of El Festival del IDQ Bloggers, which is a blog carnival for information/data quality bloggers being run as part of the celebration of the five year anniversary of the International Association for Information and Data Quality (IAIDQ).”

Business Insurance: ‘Questionable’ claims on the rise: NICB

“A down economy and mounting unemployment level is causing some people to look at insurance fraud as a possible way to make money by taking advantage of a situation, according to the NICB. The report, released Tuesday, is an analysis of questionable claims submitted by more than 1,000 NICB member companies in the first quarter of 2009 versus the same period a year ago.”

Identity Resolution Daily Links 2009-04-21

Tuesday, April 21st, 2009

By the Infoglide Team

Los Angeles Times: L.A. County reserve deputy is accused of fraud at his security firm

“Jane Robison, a spokeswoman for Dist. Atty. Steve Cooley, said the men created a shell company, International Armored Solutions Inc., to hide the true number of employees at the security firm to avoid paying higher workers’ compensation insurance premiums to the State Compensation Insurance Fund.”

ArticleRooms.com: The Benefits of Master Data Management

“Next, Master Data Management can also help prevent fraud. With the passing of Sarbanes-Oxley which holds executives of public companies accountable for their financial statement, these executives have now placed pressure on the organization to get things right.”

Greene County Daily World: Looking back: Area schools safer because of Columbine shooting incident

Fusion centers are central locations where local, state and federal officials work to receive, integrate and analyze intelligence. The ultimate goal of a fusion center is to provide a mechanism where law enforcement, public safety, and private partners can come together with a common purpose and improve the ability to safeguard our homeland and prevent criminal activity.”

SmartDataCollective: Enterprise Data World 2009

[Jim Harris] “Enterprise Data World is the business world’s most comprehensive vendor-neutral educational event about data and information management.  This year’s program was bigger than ever before, with more sessions, more case studies, and more can’t-miss content.”

All About B2B: PAXLST and CUSRES – How EDI keeps our planes safe from Terrorists

“Through government ownership, the risk of security breaches is minimized and a higher level of consistency can be enforced across airlines.  In the first phase of the program, TSA will perform screening of only US domestic flights.  In future versions of the program, monitoring will expand to include international flights as well.”

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