“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.”
“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.”
“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.’”
“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.”
“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.”
“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.”
“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.’”
“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.”
“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.’”
“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?’”
“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.
“The hottest non-fiction book at the moment is The Big Short: Inside the Doomsday Machine. Best-selling author Michael Lewis explores and explains what went on behind the scenes during the years leading up to the big stock market crash in 2008 and answers a crucial question: “Who understood the risk inherent in the assumption of ever-rising real estate prices, a risk compounded daily by the creation of those arcane, artificial securities loosely base on piles of doubtful mortgages?” While misguided government policies together with greed and stupidity provide the larger answer, events during that time beg certain questions about the specific ways in which credit risk is evaluated.”
“There have been 173 reported data breaches so far in 2010, and 34 of these involve financial services companies. This means that in less than one quarter of the year, we already have seen more than one-third of the 62 banking-related breaches reported in all of 2009… If the breach trends do continue as they did in 2009, then financial service companies will continue to experience malicious hacking and insider theft. The challenge for organizations such as the ITRC is that many organizations fail to report their breaches.”
“Both tickets were presented to Ikhlayel by undercover lottery investigators posing as customers. In both instances, Ikhlayel told the investigators the tickets were not winning tickets. An investigation indicated both tickets were validated at the Downtowner Marathon shortly after being presented to Ikhlayel, authorities said.”
“Employers that aim to lower their workers’ comp expense through dishonest means try all sorts of tricks, from under-reporting payroll to lying about the state in which their employees work. Such ruses seldom succeed since insurers regularly audit insureds for premium fraud, and they’ve seen every trick in the book. Moreover, the modest boost that premium fraud gives the bottom line is hardly worth the risk.”
“The center is not yet operating, but by as early as midsummer it will be one of more than 70 working fusion centers across the country collecting data from financial, health care, retail, energy, electronic and education sectors.”
“The ticket indicated it was a winner, and that the person who possessed it was due $20,000, Coe said. But an employee told the compliance officer the ticket was worth a $50 payout, Coe said. The woman kept the ticket after giving the Lottery employee $50, she said. On Monday, the store employee and a companion tried to claim the $20,000 ticket at Washington’s Lottery headquarters on Fourth Avenue in Olympia, according to Coe. Lottery officials called Olympia police, and officers arrested the two women.”
“The Transportation Security Administration (TSA) generally has fulfilled congressional requirements for bringing the Secure Flight program in for a landing on budget and on schedule, congressional investigators reported Tuesday.”
In March 2006, the Communications Fraud Control Association (CFCA) estimated that annual global fraud losses in the telecom sector were between $54 billion and $60 billion, and the losses continue to be substantial. Many types of fraud have been identified, but by far the most prevalent is subscription fraud.
A new subscriber signs up for mobile service using false or stolen identification, with no intention of paying the bill. Since new subscribers are given a grace period of one to three months before the account is shut off, the criminal can make thousands of dollars worth of calls before being detected.
Subscription fraud can be difficult to differentiate from simple bad debt when genuine customers are unable to pay. It’s been estimated that 30% or more of all bad debt is actually subscription fraud.
Different solutions have been tried yet fraud continues to be a problem. One common method is to look for patterns of use that suggest potential fraud, but criminals adapt and learn to probe the limits of these fraud detection systems fairly quickly.
Given the industry’s long history with fraudsters, it seems probable that enough is known about them that they could be spotted at the time they subscribe. Using similarity searching technology, would-be fraudsters can be vetted against lists of known bad actors. Using multiple public and private data sources, non-obvious relationships can highlight risky individuals, and they can then be asked to submit to a more thorough qualification process.
Identity resolution is already used across multiple industries to solve similar problems. By matching an individual’s attributes with common attributes associated with those committing fraud, the “bad guys” are being detected in areas like lottery fraud, fusion centers, insider trading, and workers’ compensation employer fraud. Part of finding the bad guys is finding hidden relationships, connections that often uncover rings of criminals.
The “birds of a feather” axiom predicts that subscription fraud criminals often share the same types of social networks. Applying identity resolution to subscription fraud problem may be the way to finally solve it.
“In the last post we looked at a formal model for describing entity-based integration. Now let’s turn our attention to how entity resolution (ER) systems are actually implemented. One of the most important design decisions is whether the system will perform entity identity management. Systems perform identity management when they create and store the attributes values for the identities that they process.”
“The two acquisitions focus the spotlight on two of the hottest functions today, in terms of user organizations adopting them, namely: MDM and identity resolution. More than ever, organizations need trusted data, in support of regulatory reporting, compliance, business intelligence, analytics, operational excellence, and other data-driven requirements. MDM and identity resolution are key enablers for these requirements, so it’s no surprise that two leading vendors have chosen to acquire these at this time.”
“Serrao says that in the time he has spent in a dozen different fusion centers in the United States — coupled with his own background in law enforcement — he’s gleaned several ‘best practices’ for consideration. Ideally, he says, leadership should ’set a specific strategic mission before the center is even built. Everything else follows. Determine the role of the center and whether strategic intelligence analysis will be part of the mix. Then, it will be easier to define what processes will be developed, what reporting mechanisms are needed, what technology is appropriate, and what types of personnel are needed.’”
“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.”
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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