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Las aseguradoras afrontan desde hace tiempo una continua batalla contra diferentes tipos de fraude. Fraude en los siniestros, fraude en la suscripción de póliza, ciberataques, fraude interno, etc. En Estados Unidos, un estudio de la Coalition Against Insurance Fraud lo estima en un total de 80.000 millones de dólares. El
It's easy to get distracted by new developments in the fight against healthcare fraud. New services. New providers. Relaxation of rules. The COVID-19 pandemic has quickly revolutionized the healthcare landscape. For instance, the government made sweeping regulatory changes to accommodate a surge in patients. Healthcare delivery and payment organizations, commercial
Je m’appelle Franck. Je suis consultant. Depuis 2003, j’accompagne de grands établissements pour renforcer leurs dispositifs de lutte contre le blanchiment (AML) et le financement du terrorisme en déployant des progiciels. 17 ans sont passés, ils fonctionnent toujours. Problème : ils sont devenus des monstres ! Je prends conscience de
Fraud, waste and abuse (FWA) ravages the US health care system. Estimates from the National Health Care Anti-Fraud Association show fraud costs health care organizations $70 billion to $230 billion each year. The precise figure is unknowable because only 3 to 10% of this fraud is ever detected. With more
Le point de vue et l’approche développée par SAS Toute entreprise ou organisation est confrontée au risque de contrepartie, dès lors qu’elle est en relation avec un tiers. Ce risque est inhérent à toute relation commerciale entre deux entités (personnes morales et/ou physiques), mais également aux dispositifs financiers tels que
The public sector is finally changing. Artificial intelligence is gradually finding its way into its administrative structures.
Analytics-based approaches in healthcare offer a new way of thinking about fraud. They are able to predict potential events.
New payment methods will deliver huge improvements in speed of transaction, but also provide challenges.
Customer identity is a precious asset and a highly prized commodity. As the financial services industry has become more digitised down the years, customers' digital identity decides what they can do and what online services they have access to. This has been revolutionary for the customer experience. So long as
Around the world, combating public sector fraud is a major problem. "Benefits cheats" get the most media attention, but are by no means the biggest loss. Tax fraud is also a huge issue. And some estimates suggest that procurement fraud could dwarf both in terms of both scale and complexity.
The financial services industry has witnessed considerable hype around artificial intelligence (AI) in recent months. We’re all seeing a slew of articles in the media, at conference keynote presentations and think-tanks tasked with leading the revolution. AI indeed appears to be the new gold rush for large organisations and FinTech
In the medical field, an autopsy is valuable because it helps you understand the cause of death. But, what’s more valuable is identifying the leading indicators of an illness so that you can address it before the Grim Reaper comes knocking. Best in class organizations are taking a similar approach
Today, fraud detection in the areas of financial services, citizen services and national security is becoming an increasingly relevant challenge for both private organisations and government agencies. The ubiquity of the internet, the e‑commerce boom and growing volumes of data processed in clouds necessitate the implementation of advanced IT tools.
This is the second of the seven parts of blog post series “A practical guide to tackle auto insurance fraud”. While Data Management and Data Quality are the basis for every analytical journey, and this becomes even more true for fraud detection analytics, the domain knowledge and business expertise plaid
To some people, electricity is like air: There for the taking. For others, circumventing paying a utility bill is a just cause, sticking it to “Big Energy” for their perceived transgressions against customers. In either case, not paying for energy is considered fraud and a crime. In some states, energy
Across the globe, governments are losing billions in revenues to organised VAT fraud. The most recent VAT Gap study published by the European Commission estimates that EU countries lost an estimated €168 billion in VAT revenues in 2013. That's equivalent to 15.2% of the total expected VAT revenue from the
With tax week quickly approaching, tax agencies have been issuing press releases alerting the public they’re holding tax refunds for review longer than in years past. This is a departure for tax agencies. Tax agencies have traditionally lived and died by refund cycle time. Refund cycle time, or getting refunds
Every day there are news stories of fraud perpetrated against federal government programs. Topping the list are Medicaid and Medicare schemes which costs taxpayers an estimated $100 billion a year. Fraud also is rampant in other important federal programs, including unemployment and disability benefits, health care, food stamps, tax collection,
When it comes to fraud detection and risk mitigation, predictive modeling has earned a reputation as the “heavy hitter” in the realm of data analytics. As our celebration of International Fraud Awareness Week continues, I would challenge our readers to ask themselves this question, “Is the reliance upon predictive analytics
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,
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
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
Fraud detection presents myriad analytical challenges: gathering sufficient known cases to make typical modeling techniques possible, gathering inputs from disparate data sources, and combining expert knowledge from investigators with findings to be gleaned from the data in an efficient way. Of course, analysts can fall into the trap of thinking
Most health care organizations either intentionally or due to some inability don’t use outside information (not just referals) in their search for fraud. There are great numbers of valid reasons for this: HIPAA, security, usable/current data sources, inflexible information systems or processes, restrictive compliance & IT departments, and the list
In the health care field, the impact of fraud, waste and abuse on payers -- whether insurance companies, government agencies or self-insured employers -- is enormous. Fraud losses weaken a payer’s financial position, with fraud loss estimates rivaling net income. Fraud losses feed the escalating care cost curve, undermining a
