Tag: fraud

Analytics | Fraud & Security Intelligence
Mike Pflug 0
What do identity thieves covet the most?

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

Analytics | Fraud & Security Intelligence
Jen Dunham 0
Fighting bribery and corruption with supplier integrity

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

Analytics | Fraud & Security Intelligence
Timo Kettunen 1
Adding insult to injury: Workplace safety and fraud

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

Analytics | Fraud & Security Intelligence
Tom Wriggins 0
Fighting fraud in the new world of Value-Based Payments

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

Artificial Intelligence | Fraud & Security Intelligence | Machine Learning
John Maynard 1
Unasked fraud questions answered by AI

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

Analytics | Data Management | Fraud & Security Intelligence
John Stultz 0
US government, analytics researchers step up fight against improper payments

  Improper payments continue to plague the federal government, though many actions are in motion to help turn the tide. The Trump Administration’s Building a Better America: A Plan for Fiscal Responsibility, released in July 2017, emphasizes reducing improper payments, currently estimated by the Government Accountability Office (GAO) to total

Analytics | Artificial Intelligence | Fraud & Security Intelligence | Machine Learning
Jen Dunham 0
Considering fraud-fighting with machine learning and artificial intelligence?

Any look back at analytics in 2017 makes it clear that machine learning and artificial intelligence appear to be the ‘next big things’ that can solve just about any problem, from writing new hit songs to curing disease. Not one to buy into the hype, I became curious as to

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