Archive for the ‘Workers Compensation Fraud’ Category

Identity Resolution Daily Links 2009-08-14

Friday, August 14th, 2009

[Post from Infoglide] Vetting Sharks and Whales

“If you’re not in the casino industry, the title of this post may be meaningless, but for casino managers, “sharks” are the bad guys and “whales” are the good guys. Sharks are people who try to defraud the casino through illegal activities, while whales are the high rollers who are apt to win $20,000 one trip and lost $25,000 the next. If there’s any environment where you’d be motivated as a businessperson to know as much as you can about who you’re dealing with, it’s a casino.”

DATAWARE HOUSING: Business Intelligence and Identity Recognition—IBM’s Entity Analytics

“This article will define master data management (MDM) and explain how customer data integration (CDI) fits within MDM’s framework. Additionally, this article will provide an understanding of how MDM and CDI differ from entity analytics, outline their practical uses, and discuss how organizations can leverage their benefits.”

Workers’Comp Kit Blog: Failure to Pay Workers Compensation Premiums

“A New York asbestos  contractor failed to pay $1.6 Million in workers’ compensation premiums and will serve four years in prison. Upon his release he will be deported to his home country as he is an illegal immigrant… He repeatedly changed the name of his company.”

The TSA Blog: Secure Flight Q&A II

“Each one of these layers alone is capable of stopping a terrorist attack. In combination their security value is multiplied, creating a much stronger, formidable system. A terrorist who has to overcome multiple security layers in order to carry out an attack is more likely to be pre-empted, deterred, or to fail during the attempt.”

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.”

What’s the Data Quality Business Message?

Wednesday, July 8th, 2009

By Robert Barker, Infoglide Senior VP & Chief Marketing Officer

What’s it going to take to move the data quality space forward in the future? That’s the question recently addressed by Ted Friedman of Gartner as reported in an article in destinationCRM.com. He suggests that the real answer may be messaging.

“Vendors have done a reasonably poor job in that they could get better at articulating the true business value [of data quality solutions],” he says. The Gartner analyst notes that vendors tend to talk about functionality in terms of technological advances, rather than conveying how that technology actually supports the business infrastructure. Friedman also notes that, in general, vendors could get better at articulating how tools support initiatives such as information governance and regulatory compliance — two notable industry trends.

Ted is right that to call out vendors to improve our messaging. At Identity Resolution Daily, we get down into technical details fairly often. For example, our bloggers have talked about data matching, its relationship to identity resolution, critical requirements for identity resolution, and we’ve had a series on data quality. Professor John Talburt of UALR’s Center for Advanced Research in Entity Resolution and Information Quality (ERIQ) is a regular contributor who talks about technical definitions and issues surrounding these topic areas.

That’s not to say that business issues around entity resolution and information quality have been ignored. Real world problems like lottery retailer fraud have been a frequent topic, as has organized retail crime. Another business problem we’ve talked about is employers trying to cheat workers compensation laws, and we’ve actually discussed regulatory compliance (OK, so we did get a bit technical on that one).

A huge issue related to information governance is preserving the rights of individual privacy. Because of our involvement in TSA’s Secure Flight program, we’ve written about this issue repeatedly since Identity Resolution was created. A recent post captures the essence of the issue.

So at best, I’d have to say we get a C+ or a B- on our messaging. With our upcoming release of IRE 2.2, we’ll make every effort to respond to Ted’s constructive criticism of the data quality space.

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 2009-06-15

Monday, June 15th, 2009

By the Infoglide Team

New England Journal of Medicine: Use of Electronic Health Records in U.S. Hospitals

“The very low levels of adoption of electronic health records in U.S. hospitals suggest that policymakers face substantial obstacles to the achievement of health care performance goals that depend on health information technology.”

Federal Computer Week: Standard updated for reporting suspicious activity

“The changes from the Office of the Director of National Intelligence’s Program Manager for the Information Sharing Environment (PM-ISE) come as that office continues a pilot program for the SAR information sharing program at sites around the country. The program uses state and local intelligence fusion centers as a node for verifying and disseminating data on suspicious activity through information technology systems.”

Travel Sentry: 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.”

Central Valley Business Times: Three accused of multi-million workers comp fraud

“‘When businesses cheat the system to save money, they are only setting themselves up to pay later — by serving time in prison,’ says state Insurance Commissioner Steve Poizner.”

Identity Resolution Daily Links 2009-06-05

Friday, June 5th, 2009

[Post from Infoglide] Entity Resolution vs. Entity Identification

“In entity resolution, as in any new research area, different authors or practitioners may use the same term but intend different meanings. You always have to be careful to understand exactly what a writer means when he or she uses a particular term.”

Ramon Chen: Shared Musings: Informatica acquires AddressDoctor GmbH - adds another MDM component

[Ramon Chen] “Outside of Informatica’s purchases, over the last few years there have been several purchases of supporting MDM products including IBM’s acquisition of Exeros, SAP buying Business Objects, who prior to that bought FirstLogic for $69M in 2006, IBM acquiring Ascential QualityStage and DataStage for $1.1B, D&B acquiring Purisma for $48M. This is a fast moving market and commodity components of the MDM lifecycle are being snapped up by the big boys faster than you can say Master D…”

Health Newstrack: Patients want computer consultations, electronic health record

“‘It seems that as the population ages and finds itself facing more illness and serious medical conditions, privacy of health information becomes much less important to patients than it is when they are healthy,’ she notes. ‘Patients are willing to trade some privacy in order to have records fully available in emergency settings and available to new caregivers as well as to multiple clinicians.’”

Information Week’s Analytics Blog: IT Fusion Centers

“The Fusion Center consolidates, analyzes, and distributes information through the many different organizations in order to enhance the ability to foresee and hopefully forestall terrorist activities. Many IT organizations are seeking to adopt the Fusion Center model as a means of obtaining a better overall view of their operations. They want to maximize resources and streamline operations just as their peers in the field of counterterrorism have done.”

Workers Comp Insider: Aging America: A Looming Catastrophe?

“The IAIABC Journal is published two times per year by the International Association of Industrial Accident Boards and Commissions (IAIABC), an association of government agencies that administer and regulate their jurisdiction’s workers’ compensation acts. It’s a peer-reviewed Journal, and one of a few remaining venues that publishes original research papers and in-depth treatment of workers compensation issues and opinions.”

Identity Resolution Daily Links 2009-05-29

Friday, May 29th, 2009

[Post from Infoglide] Identity Resolution Featured in IAIABC Journal

“If you’re not familiar with the International Association of Industrial Accident Boards & Commissions (IAIABC), it’s a very active non-profit organization of government agencies that administer workers’ compensation programs in the U.S., Canada, and other countries. In addition to sponsoring a large number of industry events including conferences and training seminars, they publish an excellent journal twice yearly that provides educational articles about education, research, and management of workers’ compensation issues.”

Boston Globe: Electronic health records raise doubt

“Personal health records, such as those offered by Google Health, are a promising tool for patients’ empowerment - but inaccuracies could be “a huge problem,” said Dr. Paul Tang, the chief medical information officer for the Palo Alto Medical Foundation, who chairs a health technology panel for the National Quality Forum.”

ITBusinessEdge: Master Data Management Can Pay off During M&As

“When companies begin mergers and acquisitions, the focus is always on the financial aspects of the deal first. Bloor Research found that 79 percent of M&A activity ignores IT integration outright. So, for many IT deparments, the real work begins after the ink has dried – a situation that some IT experts believe could contribute to the ridiculously high failure rate of M&As.”

Arizona Republic: Police agencies tout enhanced cooperation

“Just when it seemed there could be no good news about border security, law-enforcement agencies at a national conference in Phoenix engaged in a virtual group hug Wednesday, declaring that they’ve become a team.”

Identity Resolution Featured in IAIABC Journal

Wednesday, May 27th, 2009

If you’re not familiar with the International Association of Industrial Accident Boards & Commissions (IAIABC), it’s a very active non-profit organization of government agencies that administer workers’ compensation programs in the U.S., Canada, and other countries. In addition to sponsoring a large number of industry events including conferences and training seminars, they publish an excellent journal twice yearly that provides educational articles about education, research, and management of workers’ compensation issues.

The April issue of IAIABC Journal includes an article authored by Infoglide’s Charles Clendenen. “Introducing Identity Resolution: A New Approach to Workers’ Compensation Fraud” discusses three types of workers’ compensation fraud and how identity resolution (aka entity analytics or entity resolution) is being applied to make the process of finding potential employer fraud easier and more cost-effective.

While medical fraud and employee fraud are significant problems, “employer premium fraud, while less publicized, can involve millions of dollars in unpaid or underpaid premiums and can cause much more damage to the insuring agency.”

Employer premium fraud can take several forms. 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. 

Clendenen goes on to introduce identity resolution technology and discuss its origins, then talks about how it can be applied to solve workers’ comp employer fraud.

While identity resolution technologies can be applied to employee and provider fraud, they are particularly effective at uncovering employer premium fraud. Finding companies who are not registered for workers’ compensation involves comparing databases where companies are advertising themselves as open for business to lists of businesses registered with state workers’ compensation programs. The results can highlight companies who have not registered or are not paying premiums, companies who have changed their name often, and companies involved in hidden contractor/ subcontractor relationships.

The rest of the article talks in more detail about how identity resolution can be applied and the potential return on investment (ROI) agencies can expect.

Click here to read the full article, and to learn more about IAIABC, check out their web site.

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