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Managed Care
March 2006
John Carroll |
New Tools to Detect Fraud Rely on Discovering Patterns The ability of the computer to find unexpected - and often unwelcome - patterns of utilization for health insurance is at the heart of today's fraud detection methods.   |
Managed Care
July 2001
John Otrompke |
Stark Allows Federal Regulators To Review Claims Records Fully HMO executives, as well as the providers and physicians who contract with them, should have by now felt the changes in their daily work lives resulting from the government's increased scrutiny of health plans' operations under the fraud-and-abuse compliance laws... |
Managed Care
April 2005 |
Persistence Key In Blues Battle Against Fraud The health insurer's latest salvo against alleged medical crookedness was splashed across headlines around the country last month when news broke about the notorious rent-a-patient scam. |
Managed Care
April 2001
Gregory J. Borca |
Technology Curtails Health Care Fraud The amount of fraud in the health care system is staggering, but computer analysis can help reduce the level. Here is one company's strategy... |
Insurance & Technology
August 26, 2004
Babcock & McGee |
Filter Out the Frauds Health insurers fight back against fake claims with fraud-detection software. |
Reason
September 2004
Maia Szalavitz |
Dr. Feelscared U.S. drug warriors put the fear of prosecution in physicians who dare to treat pain. While the OxyContin panic does not seem to have deterred addicts, it has scared doctors. |
Insurance & Technology
April 8, 2008
Nathan Conz |
Medical Mutual of Ohio Seeks to Discourage Fraud Before It Occurs Medical Mutual of Ohio leverages ViPS' Star Sentinel software to better identify potentially fraudulent claims activity and discourage fraud before it begins. |
National Defense
August 2005
Joe Pappalardo |
Investigators Band Together Against Contracting Fraud A scandal involving the manipulation of a $20 billion contract for Air Force refueling tankers served as an impetus for an interagency effort to police government deals for abuse and conflicts of interest. More than 20 federal agencies are involved, and that list is growing. |
BusinessWeek
January 6, 2011
Justin Blum |
Why Medicare Can't Catch the Fraudsters One provider's claims were paid despite unusual billing patterns |
Insurance & Technology
August 16, 2010
Amelia Harnish |
Analytics Improving Insurers' Claims Fraud Detection Efforts Fighting claims fraud still requires legwork, but anti-fraud technologies such as analytics are streamlining and improving the investigation process. |
Managed Care
December 2000
Mark D. Abruzzo |
Some States Seek To Close Prompt-Payment Loopholes Many states have laws governing the timeliness of claims payments to physicians, hospitals, and other providers, but few such statutes have any real effect because of lack of enforcement or clarity. Some states are toughening their so-called prompt-payment laws, at the expense of insurers... |
Commercial Investment Real Estate
Sep/Oct 2009
Andrew Dick |
Deal Diagnosis Healthcare real estate transactions not only are driven by economic factors, but also by compliance with federal and state healthcare laws. |
Insurance & Technology
June 1, 2006
Maria Woehr |
Uncovering Crooked Claims Finding fraudulent claims can be challenging. But with the use of rules-based analysis, data mining and predictive modeling, insurers are waging a war on scam artists. |
Bank Technology News
November 2009
Rebecca Sausner |
AML and Fraud Get Together Experts discuss trends in fraud and AML reporting, technology and regulation. |
CFO
April 1, 2009
S.L. Mintz |
The Gauge of Innocence Fraud takes many forms. Count on all of them to increase this year. |
Commercial Investment Real Estate
Sep/Oct 2009
Andrew Dick |
Understanding Federal Healthcare Laws Commercial real estate professionals who work with medical office development must be aware of the federal healthcare fraud and abuse laws. |
Bank Systems & Technology
May 5, 2007
Maria Bruno-Britz |
Fraud Techniques Evolve in Parallel with Bank Products and Defenses As fraudsters' techniques evolve alongside the products and services offered by financial institutions, new steps must be introduced to stop them. |
U.S. Banker
December 2010
Katie Kuehner-Hebert |
Inside Jobs Large and small banks alike are dealing with a spike in fraud, much of it by trusted employees. |
Bank Technology News
October 2004
Holly Sraeel |
Fraud is Rising, But Victims, Banks are Fighting It Talk about fraud in banking circles and one will inevitably hit a nerve. |
Entrepreneur
July 2006
Jacquelyn Lynn |
Honesty Pays Insurance fraud is not only a crime - it's costly, too. |
InternetNews
November 11, 2009 |
DoJ Busts Up Eastern European Hacking Ring Feds indict seven hackers and conspirators responsible for ripping off more than $9 million from an Atlanta-based credit card processing company. |
CFO
March 1, 2011
Laton McCartney |
Where There's Smoke, There's Fraud Sarbanes-Oxley has done little to curb corporate malfeasance. Therefore, CFOs should implement a range of fraud-prevention measures. |
U.S. Banker
September 2004
Karen Krebsbach |
Security: The Inside Job Your employees wouldn't rip you off, right? Think again. Their theft will cost banks $2.4 billion this year. |
ifeminists
November 3, 2007 |
Child Support: The Fallacy, The Fraud, And The Failure The Family Law system in the U.S. is a disease-ridden, corrupt socialist system that will ultimately destroy us. |
Inc.
September 18, 2002
Carole Matthews |
Preventing Small-Business Fraud Small businesses are more likely to become the victims of fraud than larger businesses. Here's how you can prevent fraudulent activity in your workplace. |
Bank Technology News
September 2010
Tom Leuchtner |
Patrolling the Neighborhood Cyber criminals are employing increasingly sophisticated methods to perpetrate financial crimes. |
Bank Systems & Technology
November 17, 2009
Maria Bruno-Britz |
Obama Orders Creation of Financial Fraud Task Force The Financial Fraud Enforcement Task Force, an interagency initiative, will rely on the coordinated efforts of each member to prevent another financial crisis. The new task force replaces the Corporate Fraud Task Force. |
Insurance & Technology
December 21, 2009
Nathan Conz |
Insurers Leverage Data Mining and Predictive Analytics to Mitigate Increasingly Complex Fraud Schemes In the area of fraud mitigation technology, insurers are employing data mining and predictive analytics technologies in increasingly innovative ways to identify obscured data patterns and establish effective benchmarks for claims investigations. |
CFO
April 1, 2003
Julia Homer |
They ARE Out to Get You So far, relatively few executives have gone to jail for white-collar crimes. That may be about to change. |
InternetNews
April 7, 2005
Roy Mark |
Federal E-Rate Indictments Grow Six companies and five individuals charged with wire fraud, collusion, aiding and abetting, and conspiracy. |
Bank Systems & Technology
August 27, 2009
Maria Bruno-Britz |
Evolving Fraud Schemes Keep Pressure on Evolving Payments Instruments While some of the latest schemes borrow from scams past, today's fraud schemes are as sophisticated as banks' most advanced payments systems. And stopping them is still a challenge. |
National Defense
June 2012
David T. Hickey |
Small Business Compliance Issues Receive Increased Scrutiny The president and his administration, lawmakers, prosecutors, inspectors general, auditors, reporters, whistleblowers, company compliance officers, and industry watchdogs all seek to identify and eliminate fraud, waste and abuse from federal programs. |
Salon.com
April 4, 2002
Damien Cave |
No relief The war on drugs is preventing many Americans from getting desperately needed pain medicine... |
InternetNews
October 9, 2006
Roy Mark |
Feds Indict Two For Internet Scam Bogus online auctions for Hurricane Katrina victims leads to charges of wire and identity fraud. |
Bank Technology News
March 2004
Karen Krebsbach |
The Other Victims of ID Fraud Banks ID fraud is morphing into a throbbing migraine for financial services firms charged with twin challenges of increased responsibility to protect consumers and greater pressure to defend their own bottom line. |
InternetNews
October 8, 2009 |
FBI Holds Its Own Phish Phry Fed crackdown nets the largest number of defendants ever charged in a cyber crime scam. |
Bank Technology News
September 2004
Holly Sraeel |
The Skinny On Fraud: Banks Aren't That Helpful When It Hits While banks have spent scads of dollars educating the public on fraud, there's a disconnect between what banks intend to do on behalf of customers and what actually occurs once fraud is reported. |
Insurance & Technology
September 6, 2007
Nathan Conz |
Data Mining Improves Fraud Mitigation Efforts Data mining can help insurers access and leverage the institutional knowledge vital to fraud mitigation efforts that is locked inside their current and historical claims data. |
InternetNews
March 31, 2009
Kenneth Corbin |
Internet Crime Complaints Soared 33% in 2008 Driven by problems with e-commerce transactions and fraud, complaints skyrocketed last year. |
Bank Technology News
September 2006 |
Homeland Insecurity One of the toughest battles for bankers may be in combating online security breaches and sophisticated money laundering schemes. |
Managed Care
July 2000
Neville M. Bilimoria, J.D. |
HMOs Continue Losing Ground On Liability Issues at State Level The recent U.S. Supreme Court decision offers a nice breather, but executives should not let down their guard, as an Illinois ruling shows. |
National Defense
September 2007
D'Agostino & Connolly |
Contractors See Rise in Fraud Counterclaim Government contract fraud counterclaims are on the rise, and court decisions increasingly are recognizing fraud liability. |
Bank Systems & Technology
September 3, 2009
Nathan Conz |
Oracle Mantas Fraud Released The new release of Oracle Mantas Fraud gives banks an integrated view across accounts, customers and business lines to facilitate earlier detection of fraud schemes and financial crime rings, and enhance loss prevention and mitigation efforts. |
Searcher
April 2001
Carol Ebbinghouse |
You Have Been Misinformed - Now What?: Attacking Dangerous Data If you have already been the victim of fraudulent information, omission of information, misinformation, or fraud on the Internet, it is small consolation that there were ways to have prevented damages -- even if only to your pride... |
Bank Director
4th Quarter 2010
Chris Costanzo |
Don't Compromise Your Card Business Third parties can create a panoply of security challenges for card-issuing banks and the stakes today are higher than ever. |
Insurance & Technology
August 12, 2005
Wendy Toth |
Best Line Of Defense While insurance companies must secure their systems against ever-more-sophisticated attacks, they also must provide safe access to these systems for customers and business partners. |
New Architect
May 2002
Jesus Mena |
Active Fraud Prevention Using data mining to combat online theft... |
National Defense
April 2009
Hickey & Parker |
White House Kicks Off New Wave of Reforms Pledges and actions in the president's first few weeks in office, signal that increased ethics restrictions on government appointees, lobbyists and contractors have arrived. |
Bank Systems & Technology
August 24, 2006
Nancy Feig |
BITS Releases Insider Fraud Database BITS, a nonprofit consortium of 100 of the largest U.S. financial institutions, released its own insider fraud prevention service, which consists of a list of former financial institution employees who have compromised consumer information and/or knowingly caused financial losses. |
CFO
June 1, 2010
Marie Leone |
Someone Is Up to No Good Test your knowledge of the latest trends in corporate fraud. |
