A hot button issue this election season was the need to determine the eligibility of people for various government programs like the Affordable Care Act (ACA), Medicare and Medicaid, or entry into the United States as a migrant refugee. “Look, we’re facing the worst refugee crisis since the end of
On June 22nd, the U.S. Department of Justice announced the largest Medicaid fraud bust in history. The National Health Care Fraud Takedown included 301 defendants charged, $900 million in false billings, 61 medical professionals and 29 doctors, across 36 states. In another case, investigators in New York uncovered more than
Currently, most fraud detection solutions for financial crime and tax fraud are focused on risk assessing entities. That is to say, they evaluate the risk of each individual or businesses separately. While this helps prioritize risk-based investigations by alerting investigators to the likelihood of fraud, it does not necessarily maximize deterrence.
The Data For Good initiative is all about using data and analytics to improve the lives of citizens around the world – however most people wouldn’t immediately think about tax collection as a humanitarian effort. But that’s exactly how Courtney Kay-Decker, Executive Director of the Iowa Department of Revenue sees
Wer glaubt, die Digitalisierung hätte dem Thema Versicherungsbetrug den Garaus gemacht, der irrt – gewaltig. Nach wie vor ist einer von zehn gemeldeten Schäden und Ansprüchen erfunden oder manipuliert. Der Schaden: mindestens 4 Milliarden Euro allein in Deutschland – und das nur bei Sachversicherungen, also ohne Lebens- oder Krankenversicherungen. Den
Insurers are embracing digital to meet the demands of modern consumers. And, of course, there are obvious benefits to them from less costly, more streamlined interactions with their customers. The trouble is that digitisation comes with a major health warning: Unless insurers put suitable measures in place, they're at risk
Financial institutions evaluating fraud management solutions face a crowded vendor landscape. Dozens of vendors claim to offer various pieces of the puzzle. With so many choices available, how will you sort through the marketing rhetoric to find the best fit for your organization? You could assemble a team of analysts
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
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
Lately there seems to be a surge in the term machine learning. Much like big data a few years ago, machine learning is the new buzzword -- and the two terms actually go hand in hand. With increasing volumes of data now stored in distributed environments such as Hadoop, it's
¿Cuáles son los retos del sector financiero en Latinoamérica? ¿Cómo detectar y prevenir el fraude en los bancos y empresas de seguros de una vez por todas? ¿Podemos reducir el riesgo de pérdidas relacionadas con estas conductas fraudulentas? ¿Cómo minimizar los daños e impacto en la reputación organizacional? La lucha
John Beale was one of the highest paid government employees. A 10-year veteran of the Environmental Protection Agency (EPA), Beale defrauded the Federal Government of nearly $1M in employment wages and fraudulent travel. Beale came under suspicion after it was noticed that the he was still being paid wages 19
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
Identity fraud typically conjures thoughts of credit card scams or stolen Social Security numbers. Medical identity fraud is often overlooked, but can be a crime that kills. On the black market your medical identity can be worth as much as $50 per person versus $1 for a Social Security Number.
To prepare for the data challenges of 2015 and beyond, health care fraud, waste and abuse investigative units (government funded and commercial insurance plans, alike) need a data management infrastructure that provides access to data across programs, products and channels. This goes well beyond sorting and filtering small sets of
International Fraud Awareness Week begins on Monday, and you know what that means. Our intrepid team of fraud experts is taking over the State and Local Connection blog! Fellow bloggers, get ready. Each day next week one member of the SAS Fraud and Security Intelligence team will post on a
Similar to claims fraud, money laundering is seen as a victimless crime, and often glamorized in movies and books. Think “The Wolf of Wall Street” and “Scarface”. But money laundering is a SERIOUS problem. According to a 2013 report, the United Nations Office on Drugs and Crime estimates that $1.6
“Garbage in, garbage out” is more than a catchphrase – it’s the unfortunate reality in many analytics initiatives. For most analytical applications, the biggest problem lies not in the predictive modeling, but in gathering and preparing data for analysis. When the analytics seems to be underperforming, the problem almost invariably
A recent study by Bai & Anderson has found that some hospitals charge 10x (ie, 1000%) higher than the standard rates set by Medicare. Many news agencies have posted the list of the 50 US hospitals that have the highest markup. But I am more visually oriented, so of course I used SAS
According to Time Magazine, the next Ebola outbreak will cost the World Bank in excess of $30 billion dollars. In 2014, America spent in excess of $1.16 million dollars to treat two victims of the dreaded disease. While Ebola and other microorganisms of the deadly variety are scary creatures there
Tax fraud…5-7 years in prison. I thought I had it all figured out. The government wades through millions of returns and tries to issue refunds quickly. Sure, I filed over a thousand for my clients, but that’s just a blip on their radar. I never thought I’d get caught. But
Es war eines dieser Fußballspiele, das man am liebsten vergisst. Zwei Mannschaften spielen Rasenschach ohne erkennbaren Drang zum Tor und ohne erkennbares Konzept. Hätte man den Gegner vorher doch mal studiert, wüsste man, wie man den Abwehrriegel knackt, wie man gnadenloses Pressing betreibt und traumhaft herausgespielte Tore den Zuschauern als
For Parent’s Weekend this year, I needed to choose a restaurant for dinner in my son’s college town. Our extended family was attending the college football game and spending the weekend with our son. Before making my decision, I searched the internet for all the restaurants located within a reasonable
According to a 2012 report, it was estimated that over the next five years the US Internal Revenue Service (IRS) will issue more than $20 billion in potentially fraudulent tax refunds. Figures like this do little to boost taxpayers’ confidence in our nation’s tax system. And tax fraud is not
Here’s a great way to kill a conversation at the next cocktail party you attend. Start talking about the US budget deficit. You remember the deficit, right? It’s the difference between what the government collects and what it spends. In 2014, the US federal government spent $488 billion more than
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.
Not all fraud originates from the dark underground of criminal enterprises. In fact, fraud could literally be right under our noses, or in the cubicle next to us. The “Insider Threat” has many names – internal fraud, occupational fraud, even espionage – and uses authorized internal access and knowledge to
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
