Archive for the ‘Insurance’ Category

Identity Resolution Daily Links 2010-04-03

Saturday, April 3rd, 2010

[Post from Infoglide] Unobtrusive Measures and Identity Resolution

“For decades, researchers in the social sciences have used “unobtrusive measures” as defined originally in a 1966 book by Webb, Campbell, Schwartz, and Sechrest. The idea is to collect and analyze data without disturbing the subjects of the study. For example, instead of surveying subjects to find out how many candy bars they eat each day, the subjects’ garbage is searched and the number of candy wrappers is tallied.”

Information Management: TIBCO Software Acquires Netrics

“Gartner Research VP Andrew White highlighted the continued frenzy of acquisitions in the master data management space in a blog on the latest acquisition. “… this new acquisition highlights the dwindling set of data quality tools for master data management (and other interested) vendors to partner with, and/or acquire,” White wrote. “The acquisition seems logical, and good, for packaged MDM (TIBCO offers one) though; but as the music dies down, who will be left standing without a partner…”

Workers’ Comp Kit Blog: Business Owners and Secretary Facing Prison For Lying to Wiggle Out of High Premiums

“The Ventura County District Attorney’s office recently arraigned the owners, along with the company’s secretary, on five felony counts of insurance premium fraud and two counts of conspiracy to commit insurance fraud. According to authorities, the three lied to their insurer to save an estimated $500,000, making it appear their employees were more experienced than they actually were.”

SmartDataCollective: MDM Can Challenge Traditional Development Paradigms

“Dealing with imperfect data has traditionally been unacceptable because it slowed down processing; ignoring it or returning an error was a best practice. The difference about MDM development is the focus on data content (and value-based) processing.  The whole purpose MDM is to deal with all data, including the unacceptable stuff. It assumes that the data is good enough.”

Identity Resolution Daily Links 2010-03-19

Friday, March 19th, 2010

[Post from Infoglide] Recession Driving Insurance Fraud

“A recent post on McClatchy’s blog attributes growing insurance fraud to the recession: A recent survey of 37 state insurance-fraud bureaus by the Coalition Against Insurance Fraud found that the recession “appears to have had a significant impact on the incidence of fraud” last year. On average, the bureaus reported increases in case referrals and new investigations in all 15 categories of fraud the survey covers.”

Liliendahl on Data Quality: What is Data Quality anyway?

“If we look at what data quality tools today actually do, they in fact mostly support you with automation of data profiling and data matching, which is probably only some of the data quality challenges you have.”

Voice of America: Murder of US Consulate Workers in Mexico Signals New Phase in Violence

“Scott Stewart, vice president of tactical intelligence for Austin, Texas-based analysis firm Stratfor, says the killings might have been related to a recently announced U.S. plan to increase cooperation with Mexican law enforcement agencies. ‘We believe that it is likely related to a decision last month to start working more closely with the Mexican government by the Americans,” said Scott Stewart. “They were going to put some personnel into a joint fusion center in Juarez.’”

Coalition Against Insurance Fraud: False claims act for Maryland

“The Coalition issued a statement supporting the bill, saying it would serve as a deterrent and a powerful incentive for medical providers to have strong compliance programs and to “play by the rules.” False claims acts help detect fraudulent schemes that otherwise might not ever be known because they allow insiders to blow the whistle and initiate civil actions.”

Recession Driving Insurance Fraud

Wednesday, March 17th, 2010

By Infoglide Software CEO Mike Shultz

A recent post on McClatchy’s blog attributes growing insurance fraud to the recession:

A recent survey of 37 state insurance-fraud bureaus by the Coalition Against Insurance Fraud found that the recession “appears to have had a significant impact on the incidence of fraud” last year. On average, the bureaus reported increases in case referrals and new investigations in all 15 categories of fraud the survey covers.


The two largest sources of fraud listed in the CAIF study are phantom vehicle accident and staged accidents. In staged accidents, perpetrators of these crimes tend to be involved in multiple incidents. They create and leave a trail of information that remains captured in insurance company datasets. Unfortunately, many of these companies don’t take advantage of sophisticated tools that can find the crooks.

Let’s look at the example of staged vehicle crimes and how they can be stopped. A ring of people who successfully pull off a staged accident and are subsequently reimbursed by insurance companies usually decide to repeat their success. Since they fear being caught, each person takes different roles, changing his/her name and address slightly to avoid being caught by the data matching algorithms employed by insurance companies in the claims process. One person acting as driver in one staged accident plays the role of witness in the next accident and the passenger in the third. Each time an accident is reported, that person changes attributes of their identity, like name and address, to trip up existing software systems.

The state of entity resolution technology has been advancing rapidly. What used to be undetectable using “data matching” software can now be easily found using entity resolution. We’ve written before about the difference between simple data matching and entity resolution and how entity resolution enables hidden relationships to be uncovered.

Working with ambiguous data is a challenge, and it can overpower traditional data matching and fuzzy matching techniques. Entity resolution disambiguates insurance fraud data to find the hidden relationships between participants in fraud rings, allowing them to be stopped and prosecuted

Identity Resolution Daily Links 2010-03-16

Tuesday, March 16th, 2010

By the Infoglide Team

McClatchy: Recession is fueling a boom in insurance fraud

“Whether it’s worthless health plans peddled by fax, staged auto accidents, arson or slip-and-fall accidents at the local mall, insurance fraud of all kinds is booming in the recession and consumers are paying the price in higher premiums.”

SC Magazine: Technology solutions can be the resolution to terrorist threats

“Poulter said that when it comes to areas such as fraud detection and anti-money laundering (AML), identity resolution technology can assist financial institutions in combating identity fraud and leverage name matching of hidden patterns and correlations to prevent attempts to disguise identity. A single view of this information plays its part in the fight against terror, giving authorities a greater ability to prevent money laundering, which may lead to the funding of terrorist campaigns.”

Computerworld: Cloud Computing Will Cause Three IT Revolutions

“Over the next two to five years, expect to see enormous conflict about the technical pros and cons of cloud computing that will, at bottom, be motivated by the perception on the part of the participants as to whether cloud computing represents a benefit to be embraced or a threat to be resisted. In particular, cloud computing’s three characteristics — the illusion of infinite scalability, lack of a long-term commitment, and pay-by-the-use — will result in three revolutions in the way IT is performed, and each of the revolutions will have its adherents and detractors.”

Initiate blog: An Economic Business Case for Entity Resolution

“Restated, intelligence information sharing, analysis and proactive action (such as that performed by Interpol) are the most efficient way to economically battle terrorism. Interpol’s mission is to coordinate information and operations among nations, to allow countries to track criminals across borders and share information of common interest. This also happens to be a very good way to describe the business function of entity resolution technology.”

Identity Resolution Daily Links 2010-03-08

Monday, March 8th, 2010

By the Infoglide Team

tdwi: Informatica Ups the MDM Stakes

“Until now, Informatica’s MDM strategy has largely been peripheral. It had most of the tools (e.g., data integration, data quality, data profiling, and identity resolution) but tended to partner with bigger or best-of-breed players to promote MDM-oriented offerings or services… What’s risky about the acquisition of Siperian is that it imperils Informatica’s existing MDM partnerships (especially with Oracle Corp.) and compromises its neutrality pitch.”

GCN: Fusion centers to be assessed

Fusion centers will conduct self-assessments, followed by a gap analysis and peer reviews, according to officials at the National Fusion Center Association, a new not-for-profit organization based in Alexandria, Va., that represents the 72 fusion centers. The assessments are meant to determine their progress in reaching baseline capabilities. Those capabilities were created by a federal advisory committee that also wrote the original guidelines for those centers.”

WorkersCompensation.com: NYSIF Announces 154 Arrests

“Recent significant cases resulting in millions of dollars in savings to NYSIF have included claimants who receive benefits while operating businesses or remain employed in other capacities, the most prevalent type of workers’ comp. fraud. Other cases involve premium fraud, the most costly type, in construction, asbestos abatement and other contracting, including investigations in conjunction with the U.S. Department of Labor, the U.S. Postal Inspector, and local labor racketeering bureaus. Still other cases involve fraudulent provider billing.”

SignalScape: Experts Ponder Both Sides of Border Security

“The DHS has also tested mobile identification systems and created an information sharing plan with the Department of Justice which allows officials to search for criminal records. Art Macius, chief of staff at the Transportation Security Administration (TSA) added that organizations such as his and the DHS must also share information with their international counterparts. This international cooperation includes efforts such as cargo screening for commercial aircraft though efforts such as the Secure Flight program. Macius said that by this spring, the program will work with U.S. airlines to screen baggage and air cargo, and that the coverage will extend to international carriers by the end of the year.”

Identity Resolution Daily Links 2010-03-01

Monday, March 1st, 2010

By the Infoglide Team

IT-Director.com: The Informatica Event

[Philip Howard] “To begin with, the company talked about its acquisition of Siperian. I have already commented on this but one point that emerged at the conference was the way that Informatica describes Siperian as infrastructure MDM as opposed to application MDM. This is a hitherto unrecognised distinction (with respect to terminology) in the MDM market. Informatica distinguishes the former from the latter by saying that infrastructure MDM is domain and data model independent.”

Workforce Management: Medical Clinic Owners Plead No Contest to $60 Million Workers’ Compensation Fraud

“Investigators alleged that the pair purchased thousands of workers’ compensation client referrals from an attorney television advertising service. Clients were then sent to doctors who had a relationship with Premier, which would handle billing and collection work in return for a 50 percent fee for money they collected. Clients were then sent to attorneys who had a business relationship with Fish and Bacino, investigators allege. ‘Getting kickbacks for referring medical payments is illegal and drives up the costs in the system,’ California Insurance Commissioner Steve Poizner said in a statement.”

SignalScape: DC Police Chief Cathy Lanier Describes How Technology Is Changing Police Work in the Capitol

“The MPD also established a fusion center, which is responsible for the national capitol region. From a homeland security perspective, Chief Lanier said that the center collects and stores crime and terror alerts into a data warehouse.”

Injured Workers’ Law Firm Blog: Insurance Fraud Is a Huge Crime

“The fraudulent claims that can be made through insurance companies are categorized as being soft or hard. Soft fraud is the most common type of fraud and usually takes place when someone exaggerates a claim being made. Hard fraud takes place when someone deliberately plans a deceptive act such as a collision or the theft of their vehicle.”

Identity Resolution Daily Links 2010-02-20

Saturday, February 20th, 2010

[Post from Infoglide] Identity Resolution Still On the Rise

“We’ve noted several times over the past couple of years how the market visibility of entity resolution has been evolving. Now the consolidation of the master data management (MDM) market is causing even more conjecture about the crucial role of this technology.”

SIGNAL ONLINE: Good Guys Share, Bad Guys Lose

“Lindsey adds that personnel on Joint Terrorism Task Forces, in fusion centers or in other counterterrorism-related positions could benefit from the system by accessing the more complete data source and incorporating information found there into their own analyses and evaluations. ‘We’re out there for the crime fighters, but we’re also out there to prevent terrorism activities,’ he states.”

Claims Magazine: Fraud Triage Programs 

“The Federal Bureau of Investigation estimates that the total cost of insurance fraud (excluding health care) exceeds $40 billion per year. That means insurance fraud costs the average U.S. family between $400 and $700 annually in the form of increased premiums. In California alone, the Department of Insurance (CDOI) identified the potential loss from fraud in the 2007/2008 fiscal year at $1.2 billion, according to the 2008 Annual Report of the Insurance Commissioner.”

FoxNews.com: Flight Diverted to Florida Over Passenger’s Mistaken Identity

“Some airlines already have moved to a new identification program, called Secure Flight. All domestic carriers are expected to move to the new program by March. The government system will include more details about the passenger in question, including the passenger’s sex, birth date and full name as it appears on a government identification document.”

Precision Document Imaging: What is EMR?

“The American Recovery and Reinvestment Act of 2009 provides significant cash incentives to physicians who implement electronic health records. However, in order to qualify for these incentives the physician must not only have the proper software but must engage in “meaningful use” of the software. The government plans to publish the criteria for meaningful use in February 2010. ARRA incentive reimbursement to physicians will begin in 2011.”

Identity Resolution Daily Links 2009-10-09

Friday, October 9th, 2009

[Post from Infoglide] Privacy – A Dying Concept?

“An intriguing post by Nate Anderson on Ars Technica highlights a difficult reality about today’s easy availability of vast quantities of ‘anonymized’ data. Quoting from a recent paper by Paul Ohm at the University of Colorado Law School, Anderson writes that ‘as Ohm notes, this illustrates a central reality of data collection: data can either be useful or perfectly anonymous but never both.’”

ComputerworldUK: Data quality tools sub-par, says analyst

“A recent study on data quality by the Information Difference revealed that respondents view data quality as something that is not restricted to one area within the organisation. Instead, two-thirds of respondents said it is an issue spanning the entire organisation…Specifically, 81 per cent of respondents reported being focused on a broader scope than merely customer name and address data.”

BeyeNETWORK: Master Data Management and the Challenge of Reality

“One of the central problems of master data management, which is often poorly stated, is the need to determine if one individual thing is the same as another individual thing. But the only way we have to do this is by matching records, and a record is not the same as the thing it represents. Unlike The Matrix, we are more in danger of confounding two ‘realities’ rather than recognizing them as distinct.”

Information Management: Business Intelligence: A Blueprint to Success

“Fraud detection. Claims managers are using predictive analytics to help identify potentially fraudulent claims as early as the first notice of loss, and are analyzing claims costs to get a better handle on negative trends.”

Government Computer News: How entity resolution can help agencies connect the dots in investigations

“Imagine a law-enforcement scenario. A local police department has information on a crime suspect. Court systems, corrections facilities, the department of motor vehicles and even child-support enforcement may also have information on this person of interest, each specific to its own needs and applications. Implementation of an entity-centric environment would enable each of the organizations and systems to continue its operations while also providing the police a much more holistic view of the crime suspect along with potentially important pieces of information.”

Identity Resolution Daily Links 2009-9-25

Friday, September 25th, 2009

By the Infoglide Team

[Post from Infoglide] Social CRM, CDI, and Identity Resolution

“In her well-read book on CDI, Jill Dyché offers a definition of CDI that also seems to describe social CRM. Try reading her definition of CDI, replacing ‘CDI’ with ’social CRM’:  CDI is a set of procedures, controls, skills and automation that standardize and integrate customer data originating from multiple sources(1).”

Charleston Daily Mail: Former owner of WVa trucking company sentenced

“Leonard Cline formerly owned H & H Trucking. The insurance commissioner says he defrauded the old state workers’ compensation system of more than $500,000 in unpaid premiums, penalties and claims for benefits over about 10 years.”

WTVQ: Eight People Indicted for Insurance Fraud

“The US attorney’s office says the suspects intentionally damaged insured automobiles owned by other conspirators then filed claims.”

KansasCity.com: Push for electronic medical records picks up steam

“With or without health care reform this year, electronic medical records are picking up steam. Recent technological advances are easing the transition for doctors and hospitals, and there’s the little matter of the Health Information Technology for Economic and Clinical Health Act. The act, part of last spring’s stimulus package, included billions of dollars to ‘advance the use of health information technology.’ There’s plenty of advancing to do, with one group estimating that less than half the hospitals and only one in five physicians are equipped to fully use electronic records. ‘The United States is far more advanced in grocery store technology than in medical records technology,’ said Steve Lieber, president and chief executive officer of the Healthcare Information and Management Systems Society in Chicago.”

pnj.com: Man charged with workers’ comp fraud

“Florida Chief Financial Officer Alex Sink announced the arrest today in a news release. In the release, Sink said her Division of Insurance Fraud said Soto is charged with falsifying employment numbers with the intent of avoiding higher workers’ compensation premium payments.”

Federal News Radio: Update: Identity management in the Obama administration

“The alphabet soup of identity management programs from the Bush administration — HSPD-12, TWIC, Real ID, and many more — have gotten little attention publicly during the first nine months of the Obama presidency. But that doesn’t mean identity management has been ignored totally, says one senior administration official.”

London Evening Standard: Lloyd’s chief warns of more insurance fraud

“Lloyd’s of London’s chief executive Richard Ward today warned the deep recession would increase the number of fraudulent claims being made against the insurance market.”

Computerworld: Laptop searches at airports infrequent, DHS privacy report says

“The U.S. Department of Homeland Security’s annual privacy report card revealed more details on the agency’s  controversial policy involving searches of electronic devices at U.S. borders. . . . For instance, numbers released in the report indicate that warrantless searches of electronic devices at U.S. borders are occurring less frequently than some privacy and civil rights advocates might have feared. Of the more than 144 million travelers that arrived at U.S. ports of entry between Oct. 1, 2008 and May 5, 2009, searches of electronic media were conducted on 1,947 of them, the DHS said.Of this number, 696 searches were performed on laptop computers, the DHS said. Even here, not all of the laptops received an ‘in-depth’ search of the device, the report states. A search sometimes may have been as simple as turning on a device to ensure that it was what it purported to be. U.S. Customs and Border Protection agents conducted ‘in-depth’ searches on 40 laptops, but the report did not describe what an in-depth search entailed. . . . The report chronicled similar efforts to monitor the privacy implications of a range of projects that privacy groups are also watching. Examples include  Einstein 2.0 network monitoring technology that improves the ability of federal agencies to detect and respond to threats, and the  Real ID identity credentialing program. The DHS’s terror watch list program, its numerous  data mining projects  and the secure flight initiative were also mentioned in the report.”

Identity Resolution Daily Links 2009-09-14

Monday, September 14th, 2009

By the Infoglide Team

MAINJUSTICE: Report Finds Flaws in DOJ Worker Comp Oversight

[easy registration required] “The Justice Department does not have effective measures in place to prevent fraud, abuse and waste in its program to provide compensation for employees with work-related injuries or illnesses, according to a DOJ Office of Inspector General report released today.”

Information Management: HP and Informatica’s Expanded Relationship: Portent of Bigger Deals to Come?

“So is the partnership with Informatica a ‘proof of concept’ for future acquisition or is it simply HP BIS’s answer: ‘We are a services business and we will leave software to our partners’?”

FederalComputerWeek: 5 decisions that will determine the fate of e-health records

“Under the economic stimulus law passed earlier this year, as much as $45 billion will be distributed to health care providers who buy and use approved electronic health record systems. The road ahead is still bumpy for EHRs, but experts say success hinges on the outcomes of five major decisions.”

Dalton’s Blog: Migrating Data into an MDM Repository - Case Study

“Notice that if you’re using Data Federation to implement your MDM solution, there is no data migration. Data Federation acts as a virtual central repository, and as such, does not require a physical copy of your source data. Data Federation “translates” the source information in real time according to required business rules and definitions. It is, so to speak, a real-time Extract-Transform process.”

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