When we think of something “new”, we tend to picture something clean, shiny, or efficient. The new normal of fraud only checks one of those boxes, and unfortunately, that’s “efficient.” Today, scams and cyber attacks are persistent, and part of a larger ecosystem of phishing and hacking attacks by both
It is increasingly possible to use text analytics to explore different types of data. When a news story this summer caught my eye, I decided to see if I could use SAS Visual Text Analytics (VTA) and SAS Visual Analytics (VA) on customer complaints to provide information that might be
The COVID-19 pandemic forced government agencies to accelerate digital transformation efforts, and the Internal Revenue Service (IRS) was no exception. The IRS was already in a significant transition period, spurred by the Taxpayer First Act, which was signed into law in July 2019. The Act was designed to improve the
Recently nine pharmacists from across the country were charged for their part in a $12.1M health care fraud scheme. The pharmacists allegedly took money for prescription medications that were neither purchased nor dispensed. The indictments further allege that the defendants billed Medicare and Medicaid for medications that were often medically unnecessary and for some medications that were purportedly dispensed to
Bribery and corruption continue to plague governments and organizations around the world. Brazil’s Operation Car Wash, the 1MDB scandal in Malaysia, the FIFA bribery case and many others continue to make headlines. The prevalence of widespread, coordinated corruption and bribery is alarming and seems to continue to grow, despite ongoing sanctions and fines meant to deter these
If a cinderblock falls from the 4th floor of a building and crushes a construction worker’s foot, it’s terrible. If it lands on his head, it’s truly tragic. But the difference is sheer luck. Every employee deserves to return home safely from work. Unfortunately, accidents happen, which is why employers must carry mandatory workers’ compensation
Ladies and gentlemen, I give you Value-Based Payments (VBP), health care’s new magic, “silver bullet” that will solve all our fraud problems. Last month, the US Department of Health and Human Services (HHS) issued a press release entitled, “HHS Proposes Stark Law and Anti-Kickback Statute Reforms to Support Value-Based and
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
In many grocery stores throughout the country, the acronym “WIC” accompanies a number of the food items on the shelves. The letters stand for the federal “Women, Infants and Children” program that provides nutritional food to pregnant women and their young children who are in need. While this is a
Artificial intelligence often seems misunderstood, especially in fraud. The same is true of machine learning. One of the amazing things about them is they ask the unasked questions. This occurs as artificial intelligence (AI) and machine learning (ML) go about their daily work. So, what is the unasked question? Too
