Carl Hammersburg manages the SAS Government and Healthcare Risk and Fraud team, and has been with SAS since 2012. Prior to that, he spent 20 years in anti-fraud activities for Washington State’s exclusive workers’ comp insurer, the Department of Labor and Industries. In 2004, Carl formed that agency’s comprehensive fraud program, covering tax and premium audit, claim investigation, provider fraud and collections. Data sharing and investigative partnerships with other State and Federal agencies, as well as driving public availability of information and awareness served as cornerstones to the anti-fraud activities of the program. During his stewardship, audit and investigative activities doubled and outcomes tripled, based on a focus on data mining and predictive analytics that improved efficiency and case selection. Program success under Carl’s leadership resulted in awards from two successive Governors of Washington State.
If you’re in state government, you're well aware of the unprecedented challenges that come with off-the-charts unemployment numbers due to COVID-19. Crashing websites at state unemployment insurance offices and multi-hour phone hold times for the millions of people who've lost their income due to the pandemic are only the most
Healthcare fraud is alive and well. Honesty is dead and gone. There, I’ve said it. What else are we to take from surveys that find that 27% of people would sell their work passwords...44% of them for less than $1,000?* What does it mean that 37% of survey respondents think
During the week when everyone hanging onto their money until the last day files their taxes here in the U.S., I find it valuable to reflect on what won’t happen this week. Based on studies from the IRS, an estimated $458 Billion WON’T be appropriately reported or paid. This is
Welcome to the dreaded week when procrastinators embrace their fates as responsible taxpayers. While you and I may be paying our taxes, to no surprise, as much as $2 trillion in the underground economy will go unreported this year in the U.S. While that number may seem shocking, and the percentage is higher than
Barbarians are relentless, and they are inside the gates! That didn't go well for the Romans, and they had the most advanced technologies of their day. So how do we do better against the relentless waves of cyber barbarians attacking virtually everywhere? The answer to that is analytics, which offers early
Many states are starting to crack down on the serious abuses of government programs, cutting down on outright fraud as well as reducing abuses and errors. I wanted to highlight one of those, now that they've been on this path for a few years. North Carolina, where SAS is headquartered,
In Part 1 of this blog series, I touched on the problems created by the underground economy, and framed the size and scope. But important questions remain about the types of businesses that are part of the underground economy, how they do it, and what the driving forces behind this
The underground economy is driving a hole in the collection of income taxes, social security, unemployment and Medicare to the tune of hundreds of billions of dollars annually within the United States. Yet significant questions remain about how big the problem is, as well as what should be done about it.
Is fraud like a snowflake, and every one is unique? Not really. There is, however, an increasing number of methods and schemes that show up and expand the range of issues we need to look for every day. To celebrate International Fraud Awareness Week this year, I'm going to spend
There are times when I harken back to the classic television show M.A.S.H. For those of you too young to remember, the story centered around a mobile Army surgical hospital in the midst of the conflict in the Korean peninsula. While they weren't the first people to see the patient, the unit
It's time for a fall fraud roundup. Bad deeds swirl around like so many dry leaves, and I'd like to highlight a few of them this week. It can happen anywhere, even in sports, and no, I'm not picking on those shoplifting Dallas Cowboys here. An MLS referee was suspended for workers' compensation
Another day, another scam defrauding insurers and governments. For purposes of full disclosure, the case I'm highlighting today comes from Washington's Labor and Industries (L&I), the agency where I formerly worked and headed up fraud prevention efforts, and the investigation dates back to my time there. During my time there,
Data. Google uses ours every day, and most people aren't concerned. When our government is looking over our shoulders, however, tensions rise quickly. On the one end lies the recent scandals with the National Security Agency (NSA), which is apparently spying on you, me, and Angela Merkel. On the other lies case after case
Before that headline really scares you, let me clarify - there hasn't been a single fraud scheme that managed to pull off a $2 trillion haul (yet). However, the fact remains that as rising scams, schemes, the gray market, work under the table and good old tax evasion escalate, as
Sometimes, it is good to start with a confession. I filed my taxes at the last minute. It was past time to get some money back from the IRS before they could waste $60,000 on another Star Trek spoof video. Normally I'm one of those people that files in February,
Personally, I love studies. They help put things into context, and when done well, provide an independent and hopefully unbiased view of the forces that shape our lives. They are also a great way to see government funds used in strange ways. For example, the new NIOSH (National Institute for
Watching our nation approach the "fiscal cliff", and the dire predictions if we truly drive off it like the last scene in Thelma and Louise, has sharpened my view of the potential risks that huge gaps of fraud and abuse present to all of us. One of the key lessons
Independent contractor. Two very simple words that have a dramatic impact on businesses, workers, and government programs. While most people have a basic understanding of the term, they often have very little understanding of the laws governing it, which vary significantly program by program and state by state. This has
The first step is to answer the question of what “real-time” actually means. Depending on the program and industry speed of response, I’ve heard answers that varied from milliseconds for the biggest banks in processing credit card charges to 24 hours for some government programs. A better description of what
Detecting and preventing fraud isn't easy. Many tools and techniques are required, and while the digital age and advanced technologies have made fraud much easier in many ways, those same technologies have opened up new ways to combat it. One of those comes in the form of social network analysis,
We've all heard of her. A little blond girl with a penchant for trespassing, and very finicky preferences in mattresses and breakfast food. Unfortunately, Goldilocks isn't just part of a fairy tale, she is alive, well, and causing havoc throughout government. If you haven't made the connection yet, "bear" with
